=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154672541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILL P THOMPSON MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2012
-----------------------------------------------------
Last Update Date | 09/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 WILDWOOD TERRACE EXT
-----------------------------------------------------
City | YAZOO CITY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39194-7607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-571-3043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 134
-----------------------------------------------------
City | YAZOO CITY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39194-0134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-844-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | WILL P THOMPSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 662-571-3043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 00017239
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------