1952607814 NPI number — MRS. ROSSALIND MARIA THOMPSON LPN

Table of content: MRS. ROSSALIND MARIA THOMPSON LPN (NPI 1952607814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952607814 NPI number — MRS. ROSSALIND MARIA THOMPSON LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
ROSSALIND
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
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:
1952607814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 BENSON RIDGE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHONIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-760-8723
Provider Business Mailing Address Fax Number:
678-580-0444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 BENSON RDG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30058-6526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-760-8723
Provider Business Practice Location Address Fax Number:
678-580-0444
Provider Enumeration Date:
02/09/2011

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: 164W00000X , with the licence number:  LPN077685 , 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: 92-0555823 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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