Provider Demographics
NPI:1417194218
Name:R. DAVID THOMSON, MD, LLC
Entity Type:Organization
Organization Name:R. DAVID THOMSON, MD, LLC
Other - Org Name:HAMILTON MILL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-513-8882
Mailing Address - Street 1:3619 BRASELTON HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4668
Mailing Address - Country:US
Mailing Address - Phone:770-513-8882
Mailing Address - Fax:770-513-3545
Practice Address - Street 1:3619 BRASELTON HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4668
Practice Address - Country:US
Practice Address - Phone:770-513-8882
Practice Address - Fax:770-513-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty