Provider Demographics
NPI:1831937416
Name:THORNTON, LAQUINDRA (NP)
Entity type:Individual
Prefix:
First Name:LAQUINDRA
Middle Name:
Last Name:THORNTON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:LAQUINDRA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1967 ELIAM RD
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-5915
Mailing Address - Country:US
Mailing Address - Phone:706-726-7382
Mailing Address - Fax:
Practice Address - Street 1:3910 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2349
Practice Address - Country:US
Practice Address - Phone:205-644-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN255266163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse