Healthcare Provider Details

I. General information

NPI: 1497926091
Provider Name (Legal Business Name): MEGAN MICHIE THOMPSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2008
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6236 PROVIDENCE CLUB DR
MABLETON GA
30126-3697
US

IV. Provider business mailing address

6236 PROVIDENCE CLUB DR
MABLETON GA
30126-3697
US

V. Phone/Fax

Practice location:
  • Phone: 404-825-1000
  • Fax:
Mailing address:
  • Phone: 404-825-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3219
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: