Healthcare Provider Details

I. General information

NPI: 1154672541
Provider Name (Legal Business Name): WILL P THOMPSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 WILDWOOD TERRACE EXT
YAZOO CITY MS
39194-7607
US

IV. Provider business mailing address

PO BOX 134
YAZOO CITY MS
39194-0134
US

V. Phone/Fax

Practice location:
  • Phone: 662-571-3043
  • Fax:
Mailing address:
  • Phone: 901-844-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00017239
License Number StateMS

VIII. Authorized Official

Name: WILL P THOMPSON
Title or Position: SOLE MEMBER
Credential: MD
Phone: 662-571-3043