Healthcare Provider Details

I. General information

NPI: 1790108272
Provider Name (Legal Business Name): TINEKA THOMPSON M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 THORNTON RD STE U
LITHIA SPRINGS GA
30122-1558
US

IV. Provider business mailing address

4421 DENTON DR
DOUGLASVILLE GA
30135-3373
US

V. Phone/Fax

Practice location:
  • Phone: 404-729-9725
  • Fax:
Mailing address:
  • Phone: 404-729-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP008388
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: