Healthcare Provider Details

I. General information

NPI: 1124086400
Provider Name (Legal Business Name): THOMAS MANON PHILIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

IV. Provider business mailing address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4272
  • Fax: 864-725-4452
Mailing address:
  • Phone: 864-725-4272
  • Fax: 864-725-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23201
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number23201
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: