Healthcare Provider Details

I. General information

NPI: 1386214948
Provider Name (Legal Business Name): THOMAS DAVID BAINTER MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 79TH AVE N
MYRTLE BEACH SC
29572-4310
US

IV. Provider business mailing address

764 WALNUT KNOLL LN
CORDOVA TN
38018-3113
US

V. Phone/Fax

Practice location:
  • Phone: 843-948-1191
  • Fax: 843-948-1192
Mailing address:
  • Phone: 901-756-5565
  • Fax: 901-756-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2025-02023
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number96707
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: