Provider Demographics
NPI:1952411753
Name:THOMPSON, LINDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:523 HOLSTON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2148
Mailing Address - Country:US
Mailing Address - Phone:423-844-0651
Mailing Address - Fax:423-844-0433
Practice Address - Street 1:523 HOLSTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2148
Practice Address - Country:US
Practice Address - Phone:423-844-0651
Practice Address - Fax:423-844-0433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN143572084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
103957OtherANTHEM PROF TRIGON
A99174Medicare UPIN
3027891 GRP 3729687Medicare ID - Type Unspecified
137816OtherANTHEM PROF TRIGON
4093717OtherMAGELLAN SUMMIT
137802OtherANTHEM PROF TRIGON
137808OtherANTHEM PROF TRIGON
1807160OtherFIRST HEALTH
4093717OtherMAGELLAN NAVIGATOR
137804OtherANTHEM PROF TRIGON
4093717OtherMAGELLAN PINNACLE
003115F70 C06170Medicare ID - Type Unspecified