Healthcare Provider Details

I. General information

NPI: 1811203110
Provider Name (Legal Business Name): HEATHER MARY JEAN THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER THOMPSON ENSLEY M.D.

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD BLDG 9250
FORT BENNING GA
31905-2102
US

IV. Provider business mailing address

MARTIN ARMY COMMUNITY HOSPITAL 6600 VAN AALST BLVD, BLDG 9250
FORT BENNING GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-4067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number041230
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: