1821656562 NPI number — ALEXANDRA SIMONE MCCRACKEN THOMPSON

Table of content: ALEXANDRA SIMONE MCCRACKEN THOMPSON (NPI 1821656562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821656562 NPI number — ALEXANDRA SIMONE MCCRACKEN THOMPSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
ALEXANDRA
Provider Middle Name:
SIMONE MCCRACKEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1821656562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 E SCREVEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUITMAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31643-2178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-263-4061
Provider Business Mailing Address Fax Number:
229-263-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19664 VALDOSTA HWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31602-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-223-6326
Provider Business Practice Location Address Fax Number:
229-263-5950
Provider Enumeration Date:
05/29/2019

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: 183500000X , with the licence number:  RPH030997 , 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)





Copyright © 2007-2025 www.npivalidator.com