Healthcare Provider Details

I. General information

NPI: 1225193550
Provider Name (Legal Business Name): STEPHANIE GAIL THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LUKE AVE
SUMMERVILLE SC
29483-6834
US

IV. Provider business mailing address

201 E LUKE AVE
SUMMERVILLE SC
29483-6834
US

V. Phone/Fax

Practice location:
  • Phone: 843-851-0079
  • Fax: 843-873-1002
Mailing address:
  • Phone: 843-851-0079
  • Fax: 843-873-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20173
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20173
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: