MEDICARE: MR. DAVID SHANNON THOMPSON CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	01521	GA
2	224P00000X	Prosthetist	01521	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518964220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID SHANNON THOMPSON CPO

Provider Business Mailing Address
First Line	:	3501 ALTAMA AVE
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-3629
Country	:	US
Telephone Number	:	912-261-8117
Fax Number	:	912-261-8301

Provider Business Practice Location Address
First Line	:	3501 ALTAMA AVE
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-3629
Country	:	US
Telephone Number	:	912-261-8117
Fax Number	:	912-261-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/07/2007

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