Individual
DEVIDA THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1710 MANDALAY PKWY, MCDONOUGH, GA 30253-6125
(912) 604-7807
Mailing address
1710 MANDALAY PKWY, MCDONOUGH, GA 30253-6125
(912) 604-7807
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET002132
GA
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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