Healthcare Provider Details

I. General information

NPI: 1114124716
Provider Name (Legal Business Name): JOSEPH JENKINS THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 QUEENS RD STE 200
CHARLOTTE NC
28204-3578
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-343-9800
  • Fax: 704-347-2011
Mailing address:
  • Phone: 704-343-9800
  • Fax: 704-347-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2015-01265
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2015-01265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: