Healthcare Provider Details

I. General information

NPI: 1841369105
Provider Name (Legal Business Name): JAMES C THIGPEN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 VINEVILLE AVE
MACON GA
31204-1867
US

IV. Provider business mailing address

3448 VINEVILLE AVE
MACON GA
31204-1867
US

V. Phone/Fax

Practice location:
  • Phone: 478-405-0045
  • Fax: 478-405-0054
Mailing address:
  • Phone: 478-405-0045
  • Fax: 478-405-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number030228
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number030228
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: