Provider Demographics
NPI:1639217516
Name:THACKER, WILLIAM CARL (M D)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARL
Last Name:THACKER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-5092
Mailing Address - Country:US
Mailing Address - Phone:423-639-5781
Mailing Address - Fax:423-639-2218
Practice Address - Street 1:209 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5092
Practice Address - Country:US
Practice Address - Phone:423-639-5781
Practice Address - Fax:423-639-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000004219207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375846Medicare ID - Type Unspecified
TNB00313Medicare UPIN