Provider Demographics
NPI:1679774848
Name:THAMES, CORRINNE ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CORRINNE
Middle Name:ANNE
Last Name:THAMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 NEIGHBORHOOD WALK
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8643
Mailing Address - Country:US
Mailing Address - Phone:770-320-9498
Mailing Address - Fax:
Practice Address - Street 1:1701 HARDEE AVENUE
Practice Address - Street 2:
Practice Address - City:FORT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330
Practice Address - Country:US
Practice Address - Phone:404-464-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069651164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse