DR. THOMAS LEWIS SISTRUNK (NPI# 1063486843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063486843 |
| Entity Type | Individual |
| Full Name | DR. THOMAS LEWIS SISTRUNK |
| Credential | M.D. |
| Practice Address |
705 Dixie St Carrollton GA 30117-3818 |
| Mailing Address |
119 Maple St Suite 205 Carrollton GA 30117-3230 |
| Practice Telephone | 7708369660 |
| Practice Fax Number | 7708125028 |
| Mailing Telephone | 7708310751 |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2011-01-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
019424 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | BLUE CROSS BLUE SHIELD | 028143 | 01 |
| GA | 000229567B | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790050623 | Thomas Matthew Sistrunk IIi | Counselor | 2205 S Main St, A, Las Cruces, NM 88005-3113 | 2012-03-10 |
| Street Address |
705 DIXIE ST |
| City | CARROLLTON |
| State | GA |
| Zip Code | 30117-3818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407848799 | Lawrence Brett Carter | Pharmacist | 705 Dixie St, Carrollton, GA 30117-3818 | 2005-08-22 |
| 1760007322 | Crystal Renee Grayson | Nurse Anesthetist, Certified Registered | 705 Dixie St, Carrollton, GA 30117-3818 | 2020-06-10 |
| 1962025361 | Amanda Hasty Mcentyre | Dietitian, Registered | 705 Dixie St, Carrollton, GA 30117-3818 | 2020-05-20 |
| 1265055669 | Purdy Jackson | Dietitian, Registered | 705 Dixie St, Carrollton, GA 30117-3818 | 2020-05-20 |
| 1528681921 | Amanda Phillips Kranz | Dietitian, Registered | 705 Dixie St, Carrollton, GA 30117-3818 | 2020-05-20 |
| 1699396630 | Katherine Victoria White | Nurse Practitioner | 705 Dixie St, Carrollton, GA 30117-3818 | 2020-04-30 |
| 1144866047 | Jennifer Tiffany Jiles | Nurse Practitioner | 705 Dixie St, Carrollton, GA 30117-3818 | 2019-11-26 |
| 1750934733 | Tiffany Landry | Health Educator | 705 Dixie St, Carrollton, GA 30117-3818 | 2019-07-19 |
| 1104479195 | Kim Rowell | Health Educator | 705 Dixie St, Carrollton, GA 30117-3818 | 2019-07-19 |
| 1104478916 | Brandon Gabe Graves | Nurse Anesthetist, Certified Registered | 705 Dixie St, Carrollton, GA 30117-3818 | 2019-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679199392 | Southern Rad Onc LLC | Radiology | 809 South Park Street, Carrollton, GA 30117 | 2020-06-18 |
| 1093361404 | Eyedeal Eyecare LLC | Optometrist | 1735 S Us 27, Carrollton, GA 30117 | 2019-08-12 |
| 1710412473 | Janis James | Optometrist | 1735 S, Us-27, Walmart Vision Center, Carrollton, GA 30117 | 2017-05-01 |
| 1568881951 | Omar Hajmurad | Anesthesiology | 812 S Park St Ste 5, Carrollton, GA 30117 | 2014-04-14 |
| 1134550353 | Goodbodys Minor Med Express Care | Nurse Practitioner | 1670 South Park St., Carrollton, GA 30117 | 2013-12-13 |
| 1306187570 | Myriam C Vela-ortiz | Internal Medicine | 157 Clinic Ave Ste 203, Carrollton, GA 30117 | 2013-03-12 |
| 1891030201 | Air Evac Ems, Inc. | Ambulance | 827 Old Bremen Rd, Carrollton, GA 30117 | 2012-12-11 |
| 1952682486 | Angelic Wings Transport, Inc. | Non-emergency Medical Transport (VAN) | 362 B Columbia Drive, Carrollton, GA 30117 | 2011-08-29 |
| 1073819256 | Atlanta Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 812 South Park Street, Suite 2, Carrollton, GA 30117 | 2011-02-04 |
| 1255640348 | Amy Gilbert | Counselor | 515 Tanner St, Carrollton, GA 30117 | 2010-10-06 |
| Find all providers in zip 30117 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104174739 | Ritz Hospitality, LLC | Radiology | 1520 Blue Mesa Dr, Carrollton, TX 75007-6022 | 2012-08-29 |
| 1508989088 | Timothy Neal Ozburn | Radiology | 119 Maple St Ste 205, Carrollton, GA 30117-3259 | 2007-04-09 |
| 1093742694 | Alexandre Morin | Radiology | 119 Maple St, Suite 205, Carrollton, GA 30117-3230 | 2006-06-27 |
| 1962467647 | Gmn Associates | Radiology | 4343 N Josey Lane, Carrollton, TX 75010 | 2006-04-18 |
| 1265791784 | John L Bundrick | Radiology | 705 Dixie Street, Carrollton, GA 30117 | 2012-05-04 |
| 1801186689 | Sagar M Patel | Radiology | 705 Dixie Street, Carrollton, GA 30117 | 2011-04-13 |
| 1538497300 | Richard E Rosebrock | Radiology | 705 Dixie Street, Carrollton, GA 30117 | 2009-12-06 |
| 1356502538 | Brian D. Weber | Radiology | 705 Dixie Street, Carrollton, GA 30117 | 2008-06-20 |
| 1023278421 | Kandra S Vogt | Radiology | 705 Dixie Street, Carrollton, GA 30117 | 2008-06-10 |
| 1093868952 | Robert S Hyslop | Radiology | 705 Dixie Street, Carrollton, GA 30117 | 2007-01-22 |
| Find all providers in CARROLLTON | ||||
| City | CARROLLTON |
| Zip Code | 30117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.