Healthcare Provider Details

I. General information

NPI: 1346925849
Provider Name (Legal Business Name): BRITTANY DIANE THOMPSON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 10/12/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

8123 OLD POPE LN
MIDLAND GA
31820-7206
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1454
  • Fax:
Mailing address:
  • Phone: 706-616-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN274611
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN274611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: