Provider Demographics
NPI:1194004051
Name:THOMPSON, MEREDITH MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:MARIE
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:101 WAR FIGHTER WAY
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:31308-5731
Mailing Address - Country:US
Mailing Address - Phone:912-851-3277
Mailing Address - Fax:
Practice Address - Street 1:101 WAR FIGHTER WAY
Practice Address - Street 2:
Practice Address - City:BLACK CREEK
Practice Address - State:GA
Practice Address - Zip Code:31308-5731
Practice Address - Country:US
Practice Address - Phone:912-851-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008634363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical