Provider Demographics
NPI:1831199033
Name:THOMPSON, NANCY SUE (M D)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:SUE
Other - Last Name:BENNISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22848
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403-2848
Mailing Address - Country:US
Mailing Address - Phone:912-356-5643
Mailing Address - Fax:912-356-9712
Practice Address - Street 1:500 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4339
Practice Address - Country:US
Practice Address - Phone:912-356-5643
Practice Address - Fax:912-356-9712
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050065207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904538MMedicaid
39BDCCZMedicare ID - Type Unspecified
GA000904538MMedicaid