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General NPI Number Information
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NPI Number | 1598523557
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Entity Type | Individual
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Provider Name | EVAN MICHAEL THOMPSON NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 4069 CHEROKEE ST NW STE 400
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City | KENNESAW
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State | GA
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Zip | 30144-1278
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Country | US
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Telephone | 470-766-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 4655 SHALLOWFORD RD
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City | ROSWELL
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State | GA
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Zip | 30075-3127
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN295468
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License Number State | GA
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