Healthcare Provider Details

I. General information

NPI: 1912209214
Provider Name (Legal Business Name): NATALIE NICOLE THOMPSON F.N.P. C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 JOHNSON FERRY RD NE
BROOKHAVEN GA
30319-2558
US

IV. Provider business mailing address

5100 E VIRGINIA BEACH BLVD
NORFOLK VA
23502-3413
US

V. Phone/Fax

Practice location:
  • Phone: 678-732-1500
  • Fax:
Mailing address:
  • Phone: 572-616-4757
  • Fax: 855-939-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number170568
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number170568
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5005259
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182411
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: