Healthcare Provider Details

I. General information

NPI: 1861496838
Provider Name (Legal Business Name): JOHN R THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 OLDHAM DR
NOLENSVILLE TN
37135-9454
US

IV. Provider business mailing address

7216 NOLENSVILLE RD STE 200
NOLENSVILLE TN
37135-2113
US

V. Phone/Fax

Practice location:
  • Phone: 615-776-8088
  • Fax: 615-776-8012
Mailing address:
  • Phone: 615-791-2300
  • Fax: 615-791-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD020469
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: