Individual
DR. THOMAS JACKSON VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 PROVIDENCE RD, CHARLOTTE, NC 28207-1218
(704) 973-2106
(704) 973-2395
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 973-2106
(704) 973-2395
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
24305
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8984676
—
NC
Enumeration date
10/24/2005
Last updated
03/11/2015
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