Healthcare Provider Details

I. General information

NPI: 1033389960
Provider Name (Legal Business Name): THOMPSON CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BROAD ST POB 448
MANCHESTER GA
31816-2112
US

IV. Provider business mailing address

209 BROAD ST POB 448
MANCHESTER GA
31816-2112
US

V. Phone/Fax

Practice location:
  • Phone: 706-846-2215
  • Fax: 706-846-2584
Mailing address:
  • Phone: 706-846-2215
  • Fax: 706-846-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01781
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number017891
License Number StateGA

VIII. Authorized Official

Name: DR. FRANK ALAN THOMPSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 706-846-2215