Individual
BARRY LANE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2060 CENTRAL AVE, AUGUSTA, GA 30904-4177
(706) 738-4442
(770) 381-6451
Mailing address
2060 CENTRAL AVE, AUGUSTA, GA 30904-4177
(706) 738-4442
(770) 381-6451
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
013094
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000130666B
—
GA
01
—
033800
BLUE CROSS/BLUE SHIELD GA
GA
01
—
265295
FIRST HEALTH PLAN
GA
01
—
406072004
RAILROAD MEDICARE
GA
01
—
4114157
AETNA
GA
05
—
G13094
—
SC
Enumeration date
09/27/2005
Last updated
07/25/2013
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