Healthcare Provider Details

I. General information

NPI: 1952329492
Provider Name (Legal Business Name): ROBERT W THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342
US

IV. Provider business mailing address

441 LANTERN WOOD DR
SCOTTDALE GA
30079
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-1960
  • Fax: 404-785-4969
Mailing address:
  • Phone: 404-299-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number052647
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: