Healthcare Provider Details

I. General information

NPI: 1417046848
Provider Name (Legal Business Name): MARY F THORNE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 LANEY WALKER BLVD
AUGUSTA GA
30901-2960
US

IV. Provider business mailing address

309 LAKEVIEW DR
WRENS GA
30833-1038
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-5931
  • Fax:
Mailing address:
  • Phone: 706-547-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN038271
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: