Bre'Andria Kamille Thompson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11339 Issued in GA

Practice address

1128 S Park St
Carrollton, GA 30117-4450

Phone

(770) 836-0870

Fax

(770) 836-7506

NPI assigned

Jul 23, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premise Health of Georgia Medical, P.C.

  • Family Medicine Physician
  • Savannah, GA
  • NPI 1407910169
  Medicare reassignment
• Premise Health of Georgia Medical PC

  • Multi-Specialty Clinic/Center
  • Tyrone, GA
  • NPI 1932840683
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1972112100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 S PARK ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174450",
            "telephone_number": "770-836-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 S PARK ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174450",
            "telephone_number": "770-836-0870",
            "fax_number": "770-836-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "BRE'ANDRIA",
        "middle_name": "KAMILLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felicia G Thomas, M.A.,CCC-A
• Katie Dianne Thomas, DPT
• Maquissa Lashanta Thomas, MS,WHNP
• Anthony Thomason, LPC
• Alayne Christine Thompson, CRNP
• Kelly R Thompson, N.P.
• Trey B Thompson, PHARMD
• Lashondra T Thurman-Smart
• Caitlin Mehalick Tierney, D.O.
• Frederick W Tillman, O.D.

• Physician Assistant in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.