Provider Demographics
NPI:1306293022
Name:THOMPSON, HAILEY ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1001 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2161
Mailing Address - Country:US
Mailing Address - Phone:601-663-1200
Mailing Address - Fax:601-663-1286
Practice Address - Street 1:213 HOSPITAL RD E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2119
Practice Address - Country:US
Practice Address - Phone:601-663-1210
Practice Address - Fax:601-663-1211
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS26794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS26794OtherMISSISSIPPI MEDICAL LICENSE