Provider Demographics
NPI:1770813453
Name:THOMPSON, JENNY T (PT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:371 NOAH DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-8707
Mailing Address - Country:US
Mailing Address - Phone:706-253-6287
Mailing Address - Fax:888-557-0938
Practice Address - Street 1:1905 WOODSTOCK RD
Practice Address - Street 2:SUITE 3100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5616
Practice Address - Country:US
Practice Address - Phone:770-653-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5884171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor