Healthcare Provider Details

I. General information

NPI: 1003447327
Provider Name (Legal Business Name): ORLANDO THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 SEAWRIGHT DR
SAVANNAH GA
31406-2703
US

IV. Provider business mailing address

12409 LARGO DR APT 78
SAVANNAH GA
31419-2048
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-7633
  • Fax:
Mailing address:
  • Phone: 912-655-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: