MEDICARE: MS. TIMIKO C THORNHILL MSN,RN, FNP-BC, CNOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN177248	GA
2	163WR0006X	Registered Nurse First Assistant	RN177248	GA
3	163WS0121X	Plastic Surgery Registered Nurse	RN177248	GA
4	363LP2300X	Primary Care Nurse Practitioner	RN177248	GA
5	363LF0000X	Family Nurse Practitioner	RN177248	GA

General Provider Information

NPI Number	:	1790007433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIMIKO C THORNHILL MSN,RN, FNP-BC, CNOR

Provider Business Mailing Address
First Line	:	1670 CLAIRMONT RD
Second Line	:	2ND FLOOR OPERATING ROOM
City	:	DECATUR
State	:	GA
Zip	:	30033-2841
Country	:	US
Telephone Number	:	770-656-1672
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 ROSSER RD
Second Line	:
City	:	SMOKE RISE
State	:	GA
Zip	:	30087-1240
Country	:	US
Telephone Number	:	770-656-1672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	12/04/2018

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