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General NPI Number Information
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NPI Number | 1518940790
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Entity Type | Individual
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Provider Name | JILL ELLEN THOMPSON MD
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Gender | Female
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1574 UNION RD
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City | GASTONIA
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State | NC
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Zip | 28054-5633
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Country | US
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Telephone | 704-865-9114
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Fax | 704-865-9115
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Provider Business Mailing Address
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Address Line | 2230 EAST FRANKLIN BLVD SUITE 100-PMB #258
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City | GASTONIA
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State | NC
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Zip | 28054-4825
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Country | US
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Telephone | 704-853-3023
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Fax | 704-853-3024
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 63046
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 9300608
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 9300608
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 9300608
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License Number State | NC
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