Provider Demographics
NPI:1992894166
Name:THORNTON, CYNTHIA KAY (APRN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:THORNTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6553 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2641
Mailing Address - Country:US
Mailing Address - Phone:706-937-2777
Mailing Address - Fax:706-937-3012
Practice Address - Street 1:6553 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2641
Practice Address - Country:US
Practice Address - Phone:706-937-2777
Practice Address - Fax:706-937-3012
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR117550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00897828AMedicaid
GAP28331Medicare UPIN
GA00897828AMedicaid