Provider Demographics
NPI:1134216377
Name:TINA-ANN KERR THOMPSON, MD, PC
Entity type:Organization
Organization Name:TINA-ANN KERR THOMPSON, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA-ANN
Authorized Official - Middle Name:KERR
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-925-2010
Mailing Address - Street 1:1192A ROCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2903
Mailing Address - Country:US
Mailing Address - Phone:770-925-2010
Mailing Address - Fax:770-925-1665
Practice Address - Street 1:1192A ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2903
Practice Address - Country:US
Practice Address - Phone:770-925-2010
Practice Address - Fax:770-925-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty