Provider Demographics
NPI:1811444177
Name:GREGORY THOMPSON DO LLC
Entity type:Organization
Organization Name:GREGORY THOMPSON DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-793-1081
Mailing Address - Street 1:PO BOX 6506
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-6506
Mailing Address - Country:US
Mailing Address - Phone:334-793-1081
Mailing Address - Fax:334-792-7600
Practice Address - Street 1:1817 S OATES ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4449
Practice Address - Country:US
Practice Address - Phone:334-793-1081
Practice Address - Fax:334-792-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-04
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1308204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty