Provider Demographics
NPI:1124107354
Name:THOMPSON, TADD T (MD)
Entity type:Individual
Prefix:
First Name:TADD
Middle Name:T
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 D HWY 43 NORTH
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474
Mailing Address - Country:US
Mailing Address - Phone:931-964-0849
Mailing Address - Fax:931-964-0852
Practice Address - Street 1:4955 D HWY 43 NORTH
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474
Practice Address - Country:US
Practice Address - Phone:931-964-0849
Practice Address - Fax:931-964-0852
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4113803OtherBCBST
TN3732438Medicaid
TN3863972Medicaid
TN4113803OtherBCBST
TNDE2565Medicare PIN
TN3732438Medicare PIN
TN3863972Medicare PIN
TNH18863Medicare UPIN