Provider Demographics
NPI:1720517147
Name:THOMPSON, JACKSON (ATC)
Entity Type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 CROSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-7921
Mailing Address - Country:US
Mailing Address - Phone:252-915-7228
Mailing Address - Fax:
Practice Address - Street 1:296 CROSS CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537
Practice Address - Country:US
Practice Address - Phone:252-915-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer