Healthcare Provider Details

I. General information

NPI: 1689345076
Provider Name (Legal Business Name): LACHELSIE NICOLE THOMAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 GARDNER RD STE 105-106
CHARLESTON SC
29407-5768
US

IV. Provider business mailing address

1315 ASHLEY RIVER RD
CHARLESTON SC
29407-5315
US

V. Phone/Fax

Practice location:
  • Phone: 854-429-1175
  • Fax: 843-695-9467
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11782
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4133
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: