Healthcare Provider Details

I. General information

NPI: 1518940790
Provider Name (Legal Business Name): JILL ELLEN THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/14/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1574 UNION RD
GASTONIA NC
28054-5633
US

IV. Provider business mailing address

2230 EAST FRANKLIN BLVD SUITE 100-PMB #258
GASTONIA NC
28054-4825
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-9114
  • Fax: 704-865-9115
Mailing address:
  • Phone: 704-853-3023
  • Fax: 704-853-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number63046
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number9300608
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number9300608
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number9300608
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: