Healthcare Provider Details

I. General information

NPI: 1366429094
Provider Name (Legal Business Name): JOEL WESLEY THOMPSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 E WT HARRIS BLVD
CHARLOTTE NC
28215-4084
US

IV. Provider business mailing address

6010 E WT HARRIS BLVD
CHARLOTTE NC
28215-4084
US

V. Phone/Fax

Practice location:
  • Phone: 704-208-4134
  • Fax: 704-248-7845
Mailing address:
  • Phone: 704-208-4134
  • Fax: 704-248-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: