Provider Demographics
NPI:1164722468
Name:THOMPSON, PATRICE D (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3890 REDWINE RD SW STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5583
Mailing Address - Country:US
Mailing Address - Phone:404-344-0059
Mailing Address - Fax:404-344-9195
Practice Address - Street 1:3890 REDWINE RD SW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5583
Practice Address - Country:US
Practice Address - Phone:404-344-0059
Practice Address - Fax:404-344-9195
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
246ZE0600X, 390200000X
GA87303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program