Healthcare Provider Details

I. General information

NPI: 1609952688
Provider Name (Legal Business Name): JOHNETTA GIGI THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 JONESBORO RD STE 100
MCDONOUGH GA
30253-6213
US

IV. Provider business mailing address

413 RIVERWALK
MCDONOUGH GA
30252-9014
US

V. Phone/Fax

Practice location:
  • Phone: 678-935-0090
  • Fax: 678-935-0095
Mailing address:
  • Phone: 770-914-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP153018
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 119790 AP05291
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: