Provider Demographics
NPI:1184602831
Name:THOMPSON, CARL (DO)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
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 1:10820 PARKSIDE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1956
Mailing Address - Country:US
Mailing Address - Phone:865-218-7972
Mailing Address - Fax:865-218-7973
Practice Address - Street 1:10820 PARKSIDE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1956
Practice Address - Country:US
Practice Address - Phone:865-218-7972
Practice Address - Fax:865-218-7973
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1705208M00000X
NC2010-00194207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1127Medicaid
TN4106087OtherBCBS
TN3718274Medicaid
NC5914677Medicaid
TN7334697OtherAETNA
TNP00241596OtherPALMETTO GBA-RR MCR
SCNC1127Medicaid
TN3718274Medicaid
NC2075755Medicare PIN