Healthcare Provider Details

I. General information

NPI: 1952736340
Provider Name (Legal Business Name): EMILY THOMPSON ESTES RN-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 RIGGINS MILL RD
MACON GA
31217-5440
US

IV. Provider business mailing address

4164 RIGGINS MILL RD
MACON GA
31217-5440
US

V. Phone/Fax

Practice location:
  • Phone: 478-207-3946
  • Fax: 478-751-3336
Mailing address:
  • Phone: 478-207-3946
  • Fax: 478-751-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN112355
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: