Basic Information
| Provider Information | |||||||||
| NPI: | 1548238272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4371 NARROW LANE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361162971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346133680 | ||||||||
| FaxNumber: | 3346133685 | ||||||||
| Practice Location | |||||||||
| Address1: | 4371 NARROW LANE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361162971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346133680 | ||||||||
| FaxNumber: | 3346133685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21288 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080157843 | 01 | AL | RR MEDICARE | OTHER | 051055410 | 01 | AL | BC BS OF ALABAMA | OTHER | 009934280 | 05 | AL | MEDICAID | 051055410 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 000055410 | 01 | AL | MEDICARE PROVIDER | OTHER |