Provider Demographics
NPI:1497548903
Name:THOMPSON, PAM MCINTYRE OR LOU (RD LD RDN LDN)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:MCINTYRE OR LOU
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD LD RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5211
Mailing Address - Country:US
Mailing Address - Phone:912-245-1765
Mailing Address - Fax:912-537-2068
Practice Address - Street 1:1113 CENTER DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-5211
Practice Address - Country:US
Practice Address - Phone:912-245-1765
Practice Address - Fax:912-537-2068
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7635133V00000X
133V00000X
GALD000015133V00000X
SC1684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered