Provider Demographics
NPI:1619152972
Name:THOMPSON, STEPHEN LEWIS (CSA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CSA
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Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30086-0839
Mailing Address - Country:US
Mailing Address - Phone:770-761-9508
Mailing Address - Fax:770-761-9509
Practice Address - Street 1:622 PENNYLAKE LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5768
Practice Address - Country:US
Practice Address - Phone:770-761-9508
Practice Address - Fax:770-761-9509
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist