Provider Demographics
NPI:1821150608
Name:THOMPSON, MARIE PUCKETT (RN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:PUCKETT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5635
Mailing Address - Country:US
Mailing Address - Phone:770-887-3472
Mailing Address - Fax:
Practice Address - Street 1:428 CANTON RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2002
Practice Address - Country:US
Practice Address - Phone:770-781-6918
Practice Address - Fax:770-781-6929
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN026306163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health