Healthcare Provider Details

I. General information

NPI: 1750788998
Provider Name (Legal Business Name): DR. THOMAS P LENNS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 MAIN ST
HILTON HEAD SC
29926-6613
US

IV. Provider business mailing address

89 MAIN ST
HILTON HEAD SC
29926-6613
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-5305
  • Fax: 843-689-5210
Mailing address:
  • Phone: 843-681-5305
  • Fax: 843-689-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14657
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14657
License Number StateSC

VIII. Authorized Official

Name: DR. THOMAS P LENNS
Title or Position: OWNER
Credential: MD
Phone: 843-681-5305