Healthcare Provider Details

I. General information

NPI: 1811391444
Provider Name (Legal Business Name): DANIEL J. THOMPSON PAAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

3155 N POINT PKWY STE F100
ALPHARETTA GA
30005-5495
US

V. Phone/Fax

Practice location:
  • Phone: 770-645-9181
  • Fax: 770-645-8455
Mailing address:
  • Phone: 770-645-9181
  • Fax: 770-645-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number007326
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: