Individual
THOMAS C. KICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
200 BOOKER DR, WALHALLA, SC 29691-2278
(864) 656-3076
(843) 985-9562
Mailing address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1335
(843) 985-9562
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
241
SC
208D00000X
General Practice Physician
Primary
241
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000925306A
—
GA
05
—
002419
—
SC
05
—
89066G1
—
NC
Enumeration date
04/05/2006
Last updated
12/13/2023
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