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General NPI Number Information
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NPI Number | 1487336814
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Entity Type | Individual
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Provider Name | TRISTEN QUIERA THOMPSON BS, MS
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Gender | Female
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 2395 WALL ST SE STE 280
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City | CONYERS
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State | GA
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Zip | 30013-6703
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Country | US
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Telephone | 770-679-1553
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Fax |
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Provider Business Mailing Address
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Address Line | 6302 PROSE CIR
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City | COVINGTON
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State | GA
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Zip | 30016-1415
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Country | US
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Telephone | 504-339-0480
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Fax |
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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