Individual
MARY MICHELLE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SPEECH THERAPIST
Contact information
Practice address
4116 ARKWRIGHT RD, SUITE 2, MACON, GA 31210-1707
(478) 477-0601
(973) 965-4580
Mailing address
902 NORTHSIDE DR, PERRY, GA 31069-3344
(478) 987-1610
(973) 965-4580
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006626
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
487932448A
—
GA
05
—
487932448B
—
GA
05
—
487932448C
—
GA
Enumeration date
01/17/2007
Last updated
06/04/2009
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