Individual
GORDON THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
109 BEE STREET, CHARLESTON, SC 29401
(843) 572-1200
(843) 553-0424
Mailing address
109 BEE STREET, CHARLESTON, SC 29401
(843) 577-5011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20271
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080169774
RR MEDICARE
SC
05
—
202710
—
SC
01
—
GP1548
MEDICAID GROUP
SC
Enumeration date
05/17/2006
Last updated
12/11/2019
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