Individual
MRS. KELLI MARIE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
122 CANAL ST STE 104, POOLER, GA 31322-4408
(912) 450-0999
Mailing address
636 WYNDHAM WAY, POOLER, GA 31322-3623
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
268094
GA
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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