Healthcare Provider Details

I. General information

NPI: 1992767701
Provider Name (Legal Business Name): ANNETTE NIMMER THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OKATIE CENTER BLVD. S. SUITE 201
OKATIE SC
29909-7507
US

IV. Provider business mailing address

4 OKATIE CENTER BLVD. S. SUITE 201
OKATIE SC
29909-7507
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-3206
  • Fax: 843-706-3226
Mailing address:
  • Phone: 843-706-3206
  • Fax: 843-706-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11885
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: