Individual
TERRY M THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.
Contact information
Practice address
3672 MARATHON CIR, SUITE 140, AUSTELL, GA 30106-6821
(678) 738-7380
(678) 738-7382
Mailing address
PO BOX 24905, WINSTON SALEM, NC 27114-4905
(336) 397-2165
(336) 397-2167
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
49
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49
COMPOSITE STATE BOARD OF MEDICAL EXAMINERS OF GA
GA
01
—
CO 003087
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS
—
Enumeration date
08/13/2010
Last updated
08/13/2010
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