Healthcare Provider Details

I. General information

NPI: 1083662910
Provider Name (Legal Business Name): CHARLES B THOMAS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 WEST BUTLER ROAD SUITE C
MAULDIN SC
29662-4833
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

Practice location:
  • Phone: 864-277-9867
  • Fax: 864-299-3442
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12306
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: