Individual
CHARLES EVANS THOMPSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
105 BEAVER RUN, LAGRANGE, GA 30241-1519
(706) 443-4278
Mailing address
105 BEAVER RUN, LAGRANGE, GA 30241-1519
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN289843
GA
Other
Enumeration date
03/13/2024
Last updated
03/13/2024
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