1912365735 NPI number — AUTUMN JANEE THOMAS PAC

Table of content: AUTUMN JANEE THOMAS PAC (NPI 1912365735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912365735 NPI number — AUTUMN JANEE THOMAS PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
AUTUMN
Provider Middle Name:
JANEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINGLETARY
Provider Other First Name:
AUTUMN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912365735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 FRONT AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-296-7190
Provider Business Mailing Address Fax Number:
443-991-7768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5910 SUWANEE DAM RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SUGAR HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30518-5648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-326-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  7883 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)