Individual
MIRIAM THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5353 BRIDGEWATER TRCE, STONE MOUNTAIN, GA 30088-3345
(770) 873-3185
(404) 577-1025
Mailing address
5353 BRIDGEWATER TRCE, STONE MOUNTAIN, GA 30088-3345
(770) 873-3185
(404) 577-1025
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN061603
GA
Other
Enumeration date
04/29/2013
Last updated
04/29/2013
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