Provider Demographics
NPI:1194082461
Name:THIBAULT, PAULA SUE (APRN NP-C)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:SUE
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:SUE
Other - Last Name:THIBAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:118 GOLD SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6333
Mailing Address - Country:US
Mailing Address - Phone:167-880-3192
Mailing Address - Fax:
Practice Address - Street 1:3785 SIXES RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7809
Practice Address - Country:US
Practice Address - Phone:770-720-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily