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General NPI Number Information
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NPI Number | 1093814055
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSICIANS NORTH
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 309 WEST AVE
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3800
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Country | US
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Telephone | 803-279-1412
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Fax | 803-279-2858
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Provider Business Mailing Address
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Address Line | 309 WEST AVE
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3800
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Country | US
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Telephone | 803-279-1412
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Fax | 803-279-2858
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WILLIAM THURMOND III
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Credential | MD
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Telephone | 803-279-1412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12890
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SC8076
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License Number State | SC
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