Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 10297 | GA |
NPI | 1205121811 |
---|---|
Provider Name | Dr. Ceveland Thompson III |
First Address | Waycross, GA 31501-4269 |
Second Address | Waycross, GA 31501-4269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 10/06/2011 |