Provider Demographics
NPI:1376769216
Name:THOMPSON, AMY M (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1935
Mailing Address - Street 2:5717 HWY 21 S
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326
Mailing Address - Country:US
Mailing Address - Phone:912-295-5440
Mailing Address - Fax:912-295-5344
Practice Address - Street 1:5717 HWY 21 S
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5554
Practice Address - Country:US
Practice Address - Phone:912-295-5440
Practice Address - Fax:912-295-5344
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO 07003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJZPMedicare PIN
GA511I350111Medicare PIN