Provider Demographics
NPI:1811203110
Name:THOMPSON, HEATHER MARY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARY JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:THOMPSON
Other - Last Name:ENSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:MARTIN ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:6600 VAN AALST BLVD, BLDG 9250
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:6600 VAN AALST BLVD, BLDG 9250
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:762-408-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0412302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA041230OtherGEORGIA MEDICAL LICENSE