Provider Demographics
NPI:1114923547
Name:THAGGARD, WILLIAM GREG (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GREG
Last Name:THAGGARD
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 1:2024 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4130
Mailing Address - Country:US
Mailing Address - Phone:601-553-2000
Mailing Address - Fax:601-553-6746
Practice Address - Street 1:2024 15TH ST FL 2
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4130
Practice Address - Country:US
Practice Address - Phone:601-553-2000
Practice Address - Fax:601-553-6746
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12547207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123654Medicaid
MS00123654Medicaid
MSE93697Medicare UPIN
MS100000196Medicare PIN
MS1110400001Medicare NSC