Individual
DR. STEPHEN ANDREW THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
069980
GA
2080P0208X
Pediatric Infectious Diseases Physician
Primary
87514
SC
208M00000X
Hospitalist Physician
87514
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003135051A
—
GA
05
—
GA1606
—
SC
01
—
P01198991
RAILROAD MEDICARE
GA
Enumeration date
08/18/2007
Last updated
10/29/2025
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