Healthcare Provider Details

I. General information

NPI: 1124107354
Provider Name (Legal Business Name): TADD T THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 D HWY 43 NORTH
MOUNT PLEASANT TN
38474
US

IV. Provider business mailing address

4955 D HWY 43 NORTH
MOUNT PLEASANT TN
38474
US

V. Phone/Fax

Practice location:
  • Phone: 931-964-0849
  • Fax: 931-964-0852
Mailing address:
  • Phone: 931-964-0849
  • Fax: 931-964-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35372
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: