Healthcare Provider Details

I. General information

NPI: 1962511212
Provider Name (Legal Business Name): JOHN K THOMPSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6169 U S HIGHWAY 98 STE 30
HATTIESBURG MS
39402-8634
US

IV. Provider business mailing address

6169 U S HIGHWAY 98 STE 30
HATTIESBURG MS
39402-8634
US

V. Phone/Fax

Practice location:
  • Phone: 601-336-8368
  • Fax:
Mailing address:
  • Phone: 601-336-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number19031
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number19031
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number19031
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19031
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: