Provider Demographics
NPI:1871785253
Name:THOMAS, JOHN NATHANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NATHANIEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BASTILLE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7652
Mailing Address - Country:US
Mailing Address - Phone:770-460-1911
Mailing Address - Fax:770-460-1811
Practice Address - Street 1:170 BASTILLE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7652
Practice Address - Country:US
Practice Address - Phone:770-460-1911
Practice Address - Fax:770-460-1811
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005740111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician