Provider Demographics
NPI:1356865570
Name:THOMPSON, GEORGINA ANGELINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:ANGELINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:ANGELINE
Other - Last Name:THREATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 CORN CRIB DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6073
Mailing Address - Country:US
Mailing Address - Phone:407-234-9932
Mailing Address - Fax:
Practice Address - Street 1:110 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2124
Practice Address - Country:US
Practice Address - Phone:770-486-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2017-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily