Healthcare Provider Details

I. General information

NPI: 1528089240
Provider Name (Legal Business Name): CHARLES MURRY THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BOWMAN RD SUITE 304
MT PLEASANT SC
29464-3203
US

IV. Provider business mailing address

900 BOWMAN RD SUITE 304
MT PLEASANT SC
29464-3203
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-1217
  • Fax: 843-884-7796
Mailing address:
  • Phone: 843-884-1217
  • Fax: 843-884-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number207QA0000X
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: