Provider Demographics
NPI:1548201296
Name:THOMPSON, STEPHEN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 SHRINE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4325
Mailing Address - Country:US
Mailing Address - Phone:912-265-2036
Mailing Address - Fax:912-265-6779
Practice Address - Street 1:3208 SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4325
Practice Address - Country:US
Practice Address - Phone:912-265-2036
Practice Address - Fax:912-265-6779
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000747183AMedicaid