Individual provider Active NPI

Delroy Thomas, PTA

  • Physical Disabilities Residential Treatment Facility
  • McDonough, GA
National Provider Identifier
1225453079
Registry record updated Mar 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X
License
PTA001826 Issued in GA
Practice address
8099 Revere Dr
McDonough, GA 30252-8924
Phone
(404) 543-3823
NPI assigned
Mar 3, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Disabilities Residential Treatment Facility 320700000X PTA001826 GA Primary

Addresses

Primary practice location

8099 Revere Dr
McDonough, GA 30252-8924

Mailing address

8099 Revere Dr
McDonough, GA 30252-8924
Phone (404) 543-3823

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA001826GAMDPhysical Disabilities Residential Treatment Facility

NPI Registry JSON

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

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393804800000",
    "number": "1225453079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8099 REVERE DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302528924",
            "telephone_number": "404-543-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8099 REVERE DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302528924",
            "telephone_number": "404-543-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "DELROY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-03",
        "last_updated": "2014-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": "PTA001826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; 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.