Provider Demographics
NPI:1235588476
Name:THOMPSON, DOMINIQUE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:STE 175
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6403
Mailing Address - Country:US
Mailing Address - Phone:615-988-2014
Mailing Address - Fax:615-208-1303
Practice Address - Street 1:1014 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4486
Practice Address - Country:US
Practice Address - Phone:352-376-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.38116207P00000X
FLTRN23732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine