Sistrunk, Thomas Lewis

Sistrunk, Thomas Lewis is an individual health care provider with primary practice located at 705 Dixie St , Carrollton GA 30117-3818. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Sistrunk, Thomas Lewis can be contacted via phone (770) 836-9660.

Contact Information

Primary practice address
705 Dixie St Carrollton GA 30117-3818
Fax: (770) 812-5028
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 019424 Georgia

Profile Details

NPI number 1063486843
LBN Legal business name Sistrunk, Thomas Lewis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 16th, 2006
Last updated Jan 28th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063486843 NPPES
Georgia MEDICAID 000229567B
Georgia Other 028143

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