Individual
BRIAN JAMES THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3418 CASEY ST, LORIS, SC 29569-2904
(843) 756-7885
(843) 756-7855
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 756-7885
(843) 756-7855
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
83714
SC
Other
Enumeration date
03/23/2018
Last updated
09/05/2021
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