Basic Information
| Provider Information | |||||||||
| NPI: | 1386663144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4323 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155656634 | ||||||||
| FaxNumber: | 6155656677 | ||||||||
| Practice Location | |||||||||
| Address1: | 4323 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155656634 | ||||||||
| FaxNumber: | 6155656677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 05/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 08441 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 44301 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1509837 | 05 | TN | MEDICAID | 00115626 | 05 | MS | MEDICAID |