Individual
JOHN SIRDRE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
141 EDNAM DR # 104, CHARLOTTESVILLE, VA 22903-4629
(910) 691-1559
Mailing address
141 EDNAM DR # 104, CHARLOTTESVILLE, VA 22903-4629
(910) 691-1559
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390200000X
STUDENT
—
Enumeration date
01/30/2023
Last updated
01/30/2023
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