Individual
GRACE ILEX THOMPSON-BYRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1483 TOBIAS GADSON BLVD STE 201, CHARLESTON, SC 29407-4796
(843) 745-5153
(305) 891-4228
Mailing address
1065 NE 125TH ST STE 300, NORTH MIAMI, FL 33161-5833
(888) 852-6672
(305) 891-4228
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-12338
NC
363A00000X
Physician Assistant
Primary
5019
SC
Other
Enumeration date
06/06/2022
Last updated
12/26/2024
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