Healthcare Provider Details

I. General information

NPI: 1790619666
Provider Name (Legal Business Name): LEIGH LIGHT THIGPEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W HANCOCK ST
MILLEDGEVILLE GA
31061-3371
US

IV. Provider business mailing address

220 N MACON ST
MACON GA
31210-6558
US

V. Phone/Fax

Practice location:
  • Phone: 800-342-0471
  • Fax:
Mailing address:
  • Phone: 478-755-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN276510
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: