Healthcare Provider Details

I. General information

NPI: 1417452269
Provider Name (Legal Business Name): JOHN M THOMPSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 ROSWELL RD STE F240
SANDY SPRINGS GA
30342-1198
US

IV. Provider business mailing address

1975 HIGHWAY 54 W STE 205
PEACHTREE CITY GA
30269-4794
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-9131
  • Fax: 404-255-0731
Mailing address:
  • Phone: 404-255-9131
  • Fax: 404-255-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.00401
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: