Provider Demographics
NPI:1740755719
Name:THOMPSON, BYRON A
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 CAMANO WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8377
Mailing Address - Country:US
Mailing Address - Phone:888-304-0330
Mailing Address - Fax:470-488-0026
Practice Address - Street 1:533 CAMANO WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8377
Practice Address - Country:US
Practice Address - Phone:888-304-0330
Practice Address - Fax:470-488-0026
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health