Provider Demographics
NPI:1972665370
Name:THOMASON, TIMOTHY (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:THOMASON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 COMMUNITY CENTER DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6251
Mailing Address - Country:US
Mailing Address - Phone:865-446-4032
Mailing Address - Fax:865-868-4746
Practice Address - Street 1:190 COMMUNITY CENTER DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6251
Practice Address - Country:US
Practice Address - Phone:865-446-4032
Practice Address - Fax:865-868-4746
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4883909363AM0700X
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515398Medicaid
TN3388477Medicare PIN
TNP50426Medicare UPIN