Provider Demographics
NPI:1255502183
Name:CAROLYN C. THOMPSON, M.D. ; PC
Entity Type:Organization
Organization Name:CAROLYN C. THOMPSON, M.D. ; PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-874-1016
Mailing Address - Street 1:5651 FRIST BLVD STE 505
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2059
Mailing Address - Country:US
Mailing Address - Phone:615-874-1016
Mailing Address - Fax:615-874-9925
Practice Address - Street 1:5651 FRIST BLVD STE 505
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2059
Practice Address - Country:US
Practice Address - Phone:615-874-1016
Practice Address - Fax:615-874-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3133696OtherBCBST
TN3133696OtherBCBST
TN3812252Medicare PIN