Healthcare Provider Details

I. General information

NPI: 1134216377
Provider Name (Legal Business Name): TINA-ANN KERR THOMPSON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192A ROCKBRIDGE RD
STONE MOUNTAIN GA
30087-2903
US

IV. Provider business mailing address

1192A ROCKBRIDGE RD
STONE MOUNTAIN GA
30087-2903
US

V. Phone/Fax

Practice location:
  • Phone: 770-925-2010
  • Fax: 770-925-1665
Mailing address:
  • Phone: 770-925-2010
  • Fax: 770-925-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TINA-ANN KERR THOMPSON
Title or Position: FAMILY PHYSICIAN
Credential: M.D.
Phone: 770-925-2010