Provider Demographics
NPI:1952607814
Name:THOMPSON, ROSSALIND MARIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ROSSALIND
Middle Name:MARIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 BENSON RIDGE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058
Mailing Address - Country:US
Mailing Address - Phone:678-760-8723
Mailing Address - Fax:678-580-0444
Practice Address - Street 1:2305 BENSON RDG
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6526
Practice Address - Country:US
Practice Address - Phone:678-760-8723
Practice Address - Fax:678-580-0444
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN077685164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA92-0555823Medicaid