Provider Demographics
NPI:1922148394
Name:THOMPSON, GREGORY AHERN (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:AHERN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FALKIRK DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6982
Mailing Address - Country:US
Mailing Address - Phone:334-944-4010
Mailing Address - Fax:334-699-2268
Practice Address - Street 1:1909 HONEYSUCKLE RD STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4288
Practice Address - Country:US
Practice Address - Phone:334-699-5076
Practice Address - Fax:334-699-5078
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1808204D00000X, 207Q00000X
ALDO.1308207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND93067Medicare UPIN