Provider Demographics
NPI:1194416594
Name:THOMPSON, STUART JR
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HARTSFIELD CENTER PKWY STE 516
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1341
Mailing Address - Country:US
Mailing Address - Phone:478-719-0272
Mailing Address - Fax:
Practice Address - Street 1:100 HARTSFIELD CENTER PKWY STE 516
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1341
Practice Address - Country:US
Practice Address - Phone:478-719-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCHP011463376K00000X
GAPHCP011463376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide