Healthcare Provider Details

I. General information

NPI: 1285735852
Provider Name (Legal Business Name): ASHLEY A. THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ASH THOMPSON

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CARLTON STREET
ATHENS GA
30602-1503
US

IV. Provider business mailing address

55 CARLTON STREET
ATHENS GA
30602-1503
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-8638
  • Fax: 706-583-0217
Mailing address:
  • Phone: 706-542-8638
  • Fax: 706-583-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47481-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number47481-020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number066830
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number066830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: