Healthcare Provider Details

I. General information

NPI: 1699696344
Provider Name (Legal Business Name): MAURICE THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 CAPITOL KNL
FAIRBURN GA
30213-4430
US

IV. Provider business mailing address

6375 CAPITOL KNL
FAIRBURN GA
30213-4430
US

V. Phone/Fax

Practice location:
  • Phone: 470-309-7772
  • Fax:
Mailing address:
  • Phone: 470-309-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: