Provider Demographics
NPI:1033389960
Name:THOMPSON CLINIC, LLC
Entity Type:Organization
Organization Name:THOMPSON CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-846-2215
Mailing Address - Street 1:209 BROAD ST
Mailing Address - Street 2:POB 448
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-2112
Mailing Address - Country:US
Mailing Address - Phone:706-846-2215
Mailing Address - Fax:706-846-2584
Practice Address - Street 1:209 BROAD ST
Practice Address - Street 2:POB 448
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-2112
Practice Address - Country:US
Practice Address - Phone:706-846-2215
Practice Address - Fax:706-846-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01781207RG0100X
GA017891261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00864377CMedicaid
GA00864377CMedicaid