Individual
TRICIA W THACKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP-C
Contact information
Practice address
720 WESTVIEW DR SW, ATLANTA, GA 30310-1458
(404) 616-3200
Mailing address
720 WESTVIEW DR SW, ATLANTA, GA 30310-1458
(404) 616-3200
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
RN154255
GA
363LP2300X
Primary Care Nurse Practitioner
Primary
RN154255
GA
Other
Enumeration date
02/18/2013
Last updated
02/18/2013
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