Healthcare Provider Details

I. General information

NPI: 1790007433
Provider Name (Legal Business Name): TIMIKO C THORNHILL MSN,RN, FNP-BC, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5546 ROSSER RD
SMOKE RISE GA
30087-1240
US

IV. Provider business mailing address

1670 CLAIRMONT RD 2ND FLOOR OPERATING ROOM
DECATUR GA
30033-2841
US

V. Phone/Fax

Practice location:
  • Phone: 770-656-1672
  • Fax:
Mailing address:
  • Phone: 770-656-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN177248
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN177248
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN177248
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN177248
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN177248
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: