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General NPI Number Information
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NPI Number | 1679163505
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Entity Type | Individual
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Provider Name | AKEBA DEQWAN THOMPSON NP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1412 MILSTEAD AVE NE STE 100
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City | CONYERS
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State | GA
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Zip | 30012-3877
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Country | US
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Telephone | 770-483-9330
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Fax |
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Provider Business Mailing Address
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Address Line | 418 8TH AVE SW
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City | CHILDERSBURG
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State | AL
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Zip | 35044-1816
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Country | US
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Telephone | 334-610-7490
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-154430
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | GAA-NP003670
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License Number State | GA
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