1811203110 NPI number — DR. HEATHER MARY JEAN THOMPSON M.D.

Table of content: DR. HEATHER MARY JEAN THOMPSON M.D. (NPI 1811203110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811203110 NPI number — DR. HEATHER MARY JEAN THOMPSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
HEATHER
Provider Middle Name:
MARY JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENSLEY
Provider Other First Name:
HEATHER
Provider Other Middle Name:
THOMPSON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811203110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MARTIN ARMY COMMUNITY HOSPITAL
Provider Second Line Business Mailing Address:
6600 VAN AALST BLVD, BLDG 9250
Provider Business Mailing Address City Name:
FORT MOORE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARTIN ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
6600 VAN AALST BLVD, BLDG 9250
Provider Business Practice Location Address City Name:
FORT MOORE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
762-408-4067
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2010

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: 2084P0800X , with the licence number:  041230 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 041230 . This is a "GEORGIA MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".