Provider Demographics
NPI:1679577225
Name:THOMPSON-ARMANT, CAROL (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:THOMPSON-ARMANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 GEORGE C WILSON DR
Mailing Address - Street 2:STE B1
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5700
Mailing Address - Country:US
Mailing Address - Phone:706-650-0004
Mailing Address - Fax:706-650-5889
Practice Address - Street 1:1215 GEORGE C WILSON DR
Practice Address - Street 2:STE B1
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5700
Practice Address - Country:US
Practice Address - Phone:706-650-0004
Practice Address - Fax:706-650-5889
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA865263776AMedicaid