NPIMap

Angel Thomas, ARDMS, RVT

Individual provider Active NPI Diagnostic Ultrasound Physician · Port Wentworth, GA

NPI 1033738570 · NPPES record last updated Apr 26, 2020

Key facts

NPI
1033738570
Entity type
Individual (NPI type 1)
Primary specialty
Diagnostic Ultrasound Physician 2085U0001X
License
134297 (GA)
Practice address
21 Lake Shore Blvd
Port Wentworth, GA 31407-3612
Phone
(912) 704-1053
NPI assigned
Apr 14, 2020
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

  • Mobile Sonography Portable X-ray and/or Other Portable Diagnostic Imaging Supplier · Port Wentworth, GA · NPI 1821695966
    NPD

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
134297GAMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Sonography Current
since Oct 4, 2020		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Ultrasound Physician 2085U0001X 134297 GA Yes

Addresses

Primary practice location

21 Lake Shore Blvd
Port Wentworth, GA 31407-3612

Mailing address

21 Lake Shore Blvd
Port Wentworth, GA 31407-3612
Phone (912) 704-1053

Other providers in Port Wentworth, GA

All providers in Port Wentworth, GA · Diagnostic Ultrasound Physician in Georgia

Sources for this page

Verify at the official NPI Registry.