Provider Demographics
NPI:1154672541
Name:WILL P THOMPSON MD PLLC
Entity Type:Organization
Organization Name:WILL P THOMPSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILL
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-571-3043
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-0134
Mailing Address - Country:US
Mailing Address - Phone:901-844-2500
Mailing Address - Fax:
Practice Address - Street 1:269 WILDWOOD TERRACE EXT
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-7607
Practice Address - Country:US
Practice Address - Phone:662-571-3043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00017239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty