Healthcare Provider Details

I. General information

NPI: 1679163505
Provider Name (Legal Business Name): AKEBA DEQWAN THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 MILSTEAD AVE NE STE 100
CONYERS GA
30012-3877
US

IV. Provider business mailing address

418 8TH AVE SW
CHILDERSBURG AL
35044-1816
US

V. Phone/Fax

Practice location:
  • Phone: 770-483-9330
  • Fax:
Mailing address:
  • Phone: 334-610-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP003670
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-154430
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number003670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: