Provider Demographics
NPI:1750055604
Name:THOMPSON, LAUREN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SHORTER AVE NW STE 101
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4289
Mailing Address - Country:US
Mailing Address - Phone:706-676-7650
Mailing Address - Fax:
Practice Address - Street 1:167 FRANK LOTT DR
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-6041
Practice Address - Country:US
Practice Address - Phone:706-676-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer