Provider Demographics
NPI:1154539054
Name:THOMPSON, ALEXA D (NP)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD
Mailing Address - Street 2:STE C
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2701
Mailing Address - Country:US
Mailing Address - Phone:770-263-9101
Mailing Address - Fax:770-263-9102
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD
Practice Address - Street 2:STE C
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2701
Practice Address - Country:US
Practice Address - Phone:770-263-9101
Practice Address - Fax:770-263-9102
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN147104 NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA403499233DMedicaid