1538540745 NPI number — MINDY DAWN THOMPSON NP

Table of content: MINDY DAWN THOMPSON NP (NPI 1538540745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538540745 NPI number — MINDY DAWN THOMPSON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
MINDY
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538540745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4304
Provider Business Mailing Address Fax Number:
864-560-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 N HOWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANDRUM
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29356-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-457-3838
Provider Business Practice Location Address Fax Number:
864-457-4159
Provider Enumeration Date:
06/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  19479 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP3268 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: SCF9735121 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".