MEDICARE: MR. JOEL WESLEY THOMPSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	101018	NC

General Provider Information

NPI Number	:	1366429094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL WESLEY THOMPSON PA-C

Provider Business Mailing Address
First Line	:	6010 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4084
Country	:	US
Telephone Number	:	704-208-4134
Fax Number	:	704-248-7845

Provider Business Practice Location Address
First Line	:	6010 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4084
Country	:	US
Telephone Number	:	704-208-4134
Fax Number	:	704-248-7845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	04/04/2016

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