=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043296957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY L THOMPSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2005
-----------------------------------------------------
Last Update Date | 06/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 BELK BLVD
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-232-8100
-----------------------------------------------------
Fax | 662-513-1496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3340 PLAYERS CLUB PKWY STE 350
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38125-8949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-207-2032
-----------------------------------------------------
Fax | 844-752-2164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 24465
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 21416
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------