Thomas Lewis Sistrunk, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

019424 Issued in GA

Practice address

705 Dixie St
Carrollton, GA 30117-3818

Phone

(770) 836-9660

Fax

(770) 812-5028

NPI assigned

Feb 16, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1063486843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 MAPLE ST",
            "address_2": "SUITE 205",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173230",
            "telephone_number": "770-831-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-836-9660",
            "fax_number": "770-812-5028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISTRUNK",
        "first_name": "THOMAS",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "019424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000229567B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "028143",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maegan Simpkins
• Amanda Simpson
• Sims Pharmacy Inc
• Melanie Sims, NP
• Waneice Sims
• Shawn R Skalin, ED.S., LPC.
• Ashley Arrington Skinner, NP-C
• Christy Skinner, P.T.
• Gregory S Slappey, MD
• Kara Slater

• Diagnostic Radiology Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Diagnostic Radiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; 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.