Individual
TOMMY D THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
200 PATEWOOD DR, STE C 100, GREENVILLE, SC 29615-3593
(864) 454-7422
(864) 454-7374
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
866
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050PA
—
SC
01
—
P00802365
RR MEDICARE
SC
Enumeration date
07/12/2006
Last updated
01/11/2013
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