Individual
MR. TOMMY SCOTT WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
516 MONTAGUE AVE, GREENWOOD, SC 29649-1942
(864) 223-1468
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
728
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057PA
—
SC
01
—
AA76245684
MEDICARE
SC
Enumeration date
10/05/2006
Last updated
03/20/2025
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