Provider Demographics
NPI:1225583644
Name:ALBERT M THOMPSON JR PC
Entity Type:Organization
Organization Name:ALBERT M THOMPSON JR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-729-1227
Mailing Address - Street 1:102 LAKESHORE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3875
Mailing Address - Country:US
Mailing Address - Phone:912-729-2955
Mailing Address - Fax:912-882-4897
Practice Address - Street 1:102 LAKESHORE DR STE B
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3875
Practice Address - Country:US
Practice Address - Phone:912-729-2955
Practice Address - Fax:912-882-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022338261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care