Healthcare Provider Details

I. General information

NPI: 1568923134
Provider Name (Legal Business Name): THOMPSON SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ALPINE WAY
SOUTH HUNTINGTON NY
11746-4610
US

IV. Provider business mailing address

77 ALPINE WAY
SOUTH HUNTINGTON NY
11746-4610
US

V. Phone/Fax

Practice location:
  • Phone: 404-396-9039
  • Fax:
Mailing address:
  • Phone: 404-396-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES E. THOMPSON III
Title or Position: OWNER
Credential: MD
Phone: 404-396-9039