Provider Demographics
NPI:1043281207
Name:DECKER, THOMAS F (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6007
Mailing Address - Country:US
Mailing Address - Phone:912-355-2116
Mailing Address - Fax:912-355-3653
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:STE 102
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-355-2116
Practice Address - Fax:912-355-3653
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0358512085R0202X, 2085B0100X, 2085U0001X
SC163242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00334799OtherRR MCARE-SCI
FL908957800Medicaid
SCG35851Medicaid
GA000511585Medicaid
GA300029144OtherRR MCARE-CRP
GAP00866848OtherRR MCARE-OIS
GA300029144OtherRR MCARE-CRP
SC300025636Medicare ID - Type UnspecifiedRAILROAD
GA30BDDCK-CRPMedicare PIN
GAE97460Medicare UPIN
FL908957800Medicaid
GA202I303263-OISMedicare PIN