Healthcare Provider Details

I. General information

NPI: 1174572523
Provider Name (Legal Business Name): JOHN R THOMPSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E ROCHAMBEAU DR STE F230
WILLIAMSBURG VA
23188-9006
US

IV. Provider business mailing address

BOX 230 800 E ROCHAMBEAU DR STE F
WILLIAMSBURG VA
23188-9006
US

V. Phone/Fax

Practice location:
  • Phone: 757-656-2295
  • Fax: 757-210-3108
Mailing address:
  • Phone: 757-656-2295
  • Fax: 757-210-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number15609
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101279714
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: