Provider Demographics
NPI:1518940790
Name:THOMPSON, JILL ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELLEN
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 1:2230 EAST FRANKLIN BLVD
Mailing Address - Street 2:SUITE 100-PMB #258
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4825
Mailing Address - Country:US
Mailing Address - Phone:704-853-3023
Mailing Address - Fax:704-853-3024
Practice Address - Street 1:1846 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4700
Practice Address - Country:US
Practice Address - Phone:704-853-3023
Practice Address - Fax:704-853-3024
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93006082085N0700X, 208VP0014X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0060AMedicaid
NC8983308Medicaid
SCN0060AMedicaid
NCG26296Medicare UPIN