Healthcare Provider Details

I. General information

NPI: 1972467074
Provider Name (Legal Business Name): LISA THIGPEN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MOUNT PLEASANT RD
THOMSON GA
30824-8140
US

IV. Provider business mailing address

2514 GAMBLE MILL RD
AVERA GA
30803-5922
US

V. Phone/Fax

Practice location:
  • Phone: 706-597-1890
  • Fax: 706-595-3119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN259064
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: