Healthcare Provider Details

I. General information

NPI: 1972415123
Provider Name (Legal Business Name): CHRISTINA C THOMPSON MT009789
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 GA-21
RINCON GA
31326
US

IV. Provider business mailing address

485 ELM RD
ELLABELL GA
31308-4759
US

V. Phone/Fax

Practice location:
  • Phone: 912-358-8454
  • Fax: --
Mailing address:
  • Phone: 912-358-8454
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT009789
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: