Healthcare Provider Details

I. General information

NPI: 1700720992
Provider Name (Legal Business Name): MACY THORNTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 BASSETT AVE
RICHMOND VA
23225-4436
US

IV. Provider business mailing address

5224 BASSETT AVE
RICHMOND VA
23225-4436
US

V. Phone/Fax

Practice location:
  • Phone: 601-522-1560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-202614
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: