Provider Demographics
NPI:1922018159
Name:THOMPSON, ALBERT MARION JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:MARION
Last Name:THOMPSON
Suffix:JR
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:PO BOX 188
Mailing Address - Street 2:1203 N 3RD ST
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-0188
Mailing Address - Country:US
Mailing Address - Phone:912-496-2531
Mailing Address - Fax:912-496-7766
Practice Address - Street 1:1203 N 3RD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-0188
Practice Address - Country:US
Practice Address - Phone:912-496-2531
Practice Address - Fax:912-496-7766
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000230458LMedicaid
D41241Medicare UPIN
GA000230458LMedicaid