Individual
DR. DEREK THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
395 HOSPITAL BLVD, JACKSON, TN 38305-2080
(731) 664-7395
Mailing address
250 FLEETS ISLAND DR, MEMPHIS, TN 38103-9019
(256) 606-8372
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
61910
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2014
Last updated
03/11/2021
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