John Thacker II, USAF IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

655 7TH St Unit 700
Robins Afb, GA 31098-2227

Phone

(606) 923-3485

NPI assigned

Oct 20, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1023771615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SAINT AUGUSTINE DR",
            "city": "BONAIRE",
            "state": "GA",
            "postal_code": "310053782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 7TH ST UNIT 700",
            "city": "ROBINS AFB",
            "state": "GA",
            "postal_code": "310982227",
            "telephone_number": "606-923-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "JOHN",
        "name_suffix": "II",
        "credential": "USAF IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor Emmanuel Stevenson, PH.D.
• Emily Stolten, D.O.
• Emmalyn V. Tague, PHYSICIAN ASSOCIATE
• Ashley Tarrant, PSY.D.
• Marvin Eugene Taylor, MD, MPH
• Nina Elizabeth Thomason, MD
• William Parham Thornton, M.D.
• David Francis Ubelhor, MSW, BCD
• Sylvia Valverde, AU.D
• Kathryn G Vasios, PA-C

• Independent Duty Medical Technicians in Robins Afb, GA
• Providers in Robins Afb, GA by specialty
• Independent Duty Medical Technicians in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.