MEDICARE: MARY STEVENSON THOMPSON MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	92072	GA

General Provider Information

NPI Number	:	1922661933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY STEVENSON THOMPSON MD

Provider Business Mailing Address
First Line	:	6095 BARFIELD RD STE 200
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4408
Country	:	US
Telephone Number	:	404-256-2638
Fax Number	:

Provider Business Practice Location Address
First Line	:	6095 BARFIELD RD STE 200
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4408
Country	:	US
Telephone Number	:	404-256-2638
Fax Number	:

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

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	08/03/2022

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