NPIMap

Organization Active NPI

Mary Grace Thomas, PH.D.,P.C.

  • Psychologist
  • Suwanee, GA
National Provider Identifier
1073848891
Registry record updated Oct 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1806 Issued in GA
Legal business name
MARY GRACE THOMAS, PH.D.,P.C.
Practice address
4411 Suwanee Dam Rd
Suite 920
Suwanee, GA 30024-8701
Phone
(678) 714-9590
Fax
(678) 714-9535
NPI assigned
Oct 13, 2009
Last updated
Oct 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2009

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

Authorized official

Name
Dr. Mary Grace Thomas, PH.D.NPI 1376616334
Title
Licensed Psychologist
Phone
(678) 714-9590

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1806 GA Primary

Addresses

Primary practice location

4411 Suwanee Dam Rd
Suite 920
Suwanee, GA 30024-8701

Mailing address

4411 Suwanee Dam Rd
Suite 920
Suwanee, GA 30024-8701
Phone (678) 714-9590

Other identifiers 1

IdentifierTypeStateIssuer
00614545AMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255392000000",
    "number": "1073848891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 SUWANEE DAM RD",
            "address_2": "SUITE 920",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300248701",
            "telephone_number": "678-714-9590",
            "fax_number": "678-714-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SUWANEE DAM RD",
            "address_2": "SUITE 920",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300248701",
            "telephone_number": "678-714-9590",
            "fax_number": "678-714-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY GRACE THOMAS, PH.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-13",
        "last_updated": "2009-10-13",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "678-714-9590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "1806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00614545A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; 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.