Provider Demographics
NPI:1659086296
Name:THOMISON, CAROL (MSN, AGPCNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:THOMISON
Suffix:
Gender:F
Credentials:MSN, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TRAIL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2127
Mailing Address - Country:US
Mailing Address - Phone:423-355-9681
Mailing Address - Fax:781-384-6201
Practice Address - Street 1:110 PARK CITY RD
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-3980
Practice Address - Country:US
Practice Address - Phone:423-355-9681
Practice Address - Fax:781-384-6201
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32976363LA2200X
GARN247679363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health