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General NPI Number Information
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NPI Number | 1770808420
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Entity Type | Organization
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Legal Business Name | KEITH P. THOMPSON MD PC
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 4505 ASHFORD DUNWOODY ROAD SUITE 15
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City | ATLANTA
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State | GA
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Zip | 30346-1516
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Country | US
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Telephone | 678-666-5076
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Fax | 678-666-5076
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Provider Business Mailing Address
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Address Line | 4505 ASHFORD DUNWOODY ROAD SUITE 15
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City | ATLANTA
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State | GA
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Zip | 30346-1516
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Country | US
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Telephone | 678-666-5076
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Fax | 678-666-5076
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Authorized Official
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Title or Position | OWNER
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Name | KEITH P THOMPSON
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Credential | M.D.
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Telephone | 678-666-5076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 031339
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License Number State | GA
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