Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | RN164801 | GA |
NPI | 1013061043 |
---|---|
Provider Name | Jill M Thompson |
First Address | Atlanta, GA 30305 |
Second Address | Duluth, GA 30096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 01/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285718185A | (05) | GA |
285718185A | PEACH STATE (01) | GA |
285718185A | WELLCARE (01) | GA |