Healthcare Provider Details

I. General information

NPI: 1962361618
Provider Name (Legal Business Name): RATHOMPSON IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7511 HIGHWAY 76 STE 400
PENDLETON SC
29670-9291
US

IV. Provider business mailing address

7511 HIGHWAY 76 STE 400
PENDLETON SC
29670-9291
US

V. Phone/Fax

Practice location:
  • Phone: 864-502-0102
  • Fax:
Mailing address:
  • Phone: 864-502-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD ALLEN THOMPSON
Title or Position: OWNER
Credential:
Phone: 770-617-2913