Individual
STEPHEN W THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1003 CHAFEE AVE, AUGUSTA, GA 30904-5867
(706) 721-2426
Mailing address
1120 15TH ST STE BI1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
005595
GA
363AS0400X
Surgical Physician Assistant
10000117A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000108476
ANTHEM
—
05
—
0834PA
—
SC
05
—
156406219A
—
GA
05
—
9500118600
—
KY
Enumeration date
08/04/2006
Last updated
01/03/2019
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