Individual
DR. LAWRENCE PHILLIPS THACKSTON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
646 RIVERS TURN ROAD, ORANGEBURG, SC 29115
(803) 536-0511
Mailing address
646 RIVERS TURN ROAD, ORANGEBURG, SC 29115
(803) 536-0511
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MMD4125
SC
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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