Provider Demographics
NPI:1053827576
Name:THOMPSON, MARCUS EDWARD
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:EDWARD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BIG STATION CAMP BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8466
Mailing Address - Country:US
Mailing Address - Phone:615-328-3400
Mailing Address - Fax:
Practice Address - Street 1:225 BIG STATION CAMP BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-8466
Practice Address - Country:US
Practice Address - Phone:615-328-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN000023631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily