Provider Demographics
NPI:1710206552
Name:THOMPSON, GRADY AUSBORNE (MD)
Entity Type:Individual
Prefix:
First Name:GRADY
Middle Name:AUSBORNE
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 1:2336 DAWSON RD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2800
Mailing Address - Country:US
Mailing Address - Phone:229-312-8750
Mailing Address - Fax:229-312-8765
Practice Address - Street 1:2336 DAWSON RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2800
Practice Address - Country:US
Practice Address - Phone:229-312-8750
Practice Address - Fax:229-312-8765
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine