Individual
BEVERLY B THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1416 WEYERHAEUSER RD, LYONS, GA 30436-2608
(912) 526-6732
Mailing address
1416 WEYERHAEUSER RD, LYONS, GA 30436-2608
(912) 526-6732
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001980
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00658369B
—
GA
01
—
10049370
AMERIGROUP PROVIDER #
GA
01
—
341006
WELLCARE PROVIDER #
GA
Enumeration date
11/29/2006
Last updated
07/09/2007
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