Provider Demographics
NPI:1619856119
Name:ROOT THOMPSON, MANDY ROOT (CMI)
Entity type:Individual
Prefix:MS
First Name:MANDY
Middle Name:ROOT
Last Name:ROOT THOMPSON
Suffix:
Gender:F
Credentials:CMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 BATTLE CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-1258
Mailing Address - Country:US
Mailing Address - Phone:614-226-0163
Mailing Address - Fax:
Practice Address - Street 1:9009 BATTLE CT
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-1258
Practice Address - Country:US
Practice Address - Phone:614-226-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other