Provider Demographics
NPI:1962511212
Name:THOMPSON, JOHN K (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
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 1:6169 U S HIGHWAY 98
Mailing Address - Street 2:STE 30
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8634
Mailing Address - Country:US
Mailing Address - Phone:601-336-8368
Mailing Address - Fax:
Practice Address - Street 1:6169 U S HIGHWAY 98
Practice Address - Street 2:STE 30
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8634
Practice Address - Country:US
Practice Address - Phone:601-336-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19031204D00000X, 2083P0901X, 2086S0129X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09006590Medicaid
MS3415028OtherAMERICAN ADMIN GROUP
MS09006590Medicaid
MS770000020Medicare PIN
I36180Medicare UPIN