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General NPI Number Information
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NPI Number | 1164722468
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Entity Type | Individual
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Provider Name | PATRICE D. THOMPSON MD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1401 GEORGIAN PARK STE 200
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-6974
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Country | US
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Telephone | 770-632-8909
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Fax |
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Provider Business Mailing Address
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Address Line | 3890 REDWINE RD SW STE 100
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City | ATLANTA
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State | GA
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Zip | 30331-5583
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Country | US
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Telephone | 404-344-0059
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Fax | 404-344-9195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 87303
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License Number State | GA
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