Provider Demographics
NPI:1205093465
Name:THOMPSON, RONALD T (PA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:365 N JEFF DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1627
Mailing Address - Country:US
Mailing Address - Phone:770-461-5003
Mailing Address - Fax:770-461-4939
Practice Address - Street 1:365 N JEFF DAVIS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1627
Practice Address - Country:US
Practice Address - Phone:770-461-5003
Practice Address - Fax:770-461-4939
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant