Provider Demographics
NPI:1447465950
Name:THOMPSON, ADAM DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-575-3923
Mailing Address - Fax:910-575-3926
Practice Address - Street 1:75 EMERSON BAY RD STE 102
Practice Address - Street 2:
Practice Address - City:CAROLINA SHORES
Practice Address - State:NC
Practice Address - Zip Code:28467-2498
Practice Address - Country:US
Practice Address - Phone:910-579-8363
Practice Address - Fax:910-575-3926
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000874363AM0700X
NC0010-00874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447465950Medicaid