Provider Demographics
NPI:1366065575
Name:THOMPSON, JEFFERY W (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DAYTON MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1047
Mailing Address - Country:US
Mailing Address - Phone:423-428-9291
Mailing Address - Fax:423-428-9281
Practice Address - Street 1:215 DAYTON MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1047
Practice Address - Country:US
Practice Address - Phone:423-428-9291
Practice Address - Fax:423-428-9291
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
TNL000000026358253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNL000000026358OtherDEPT OF MENTAL HEALTH AND SUBSTANCCE ABUSE SERVICES