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NPI Code Detail

MEDICARE: JERRY TODD THOMPSON DO

MEDICARE: JERRY TODD THOMPSON DO
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
1207Q00000XFamily Medicine Physician89489GA

General Provider Information

NPI Number : 1659869634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY TODD THOMPSON DO
Provider Business Mailing Address
First Line : 420 E 2ND AVE STE 103
Second Line :
City : ROME
State : GA
Zip : 30161-3210
Country : US
Telephone Number : 706-509-3000
Fax Number :
Provider Business Practice Location Address
First Line : 2370 ROCKMART HWY STE 100
Second Line :
City : CEDARTOWN
State : GA
Zip : 30125-6029
Country : US
Telephone Number : 706-509-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2018
Last Update Date : 03/10/2023

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