Healthcare Provider Details

I. General information

NPI: 1689182685
Provider Name (Legal Business Name): CANDACE ANNETTE THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 BEST RD STE 150
ATLANTA GA
30337-5601
US

IV. Provider business mailing address

261 LINDA LN SE
MABLETON GA
30126-4329
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-2222
  • Fax:
Mailing address:
  • Phone: 404-996-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN237018
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN237018
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN237018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: