Healthcare Provider Details

I. General information

NPI: 1629098280
Provider Name (Legal Business Name): THOMAS BOYNE PLATT CPRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY VA MEDICAL CENTER, #267
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

325 CLEMSON ST
CLEMSON SC
29631-2836
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-731-7165
Mailing address:
  • Phone: 864-654-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: