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General NPI Number Information
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NPI Number | 1144653742
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Entity Type | Individual
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Provider Name | CARRIE MARIE THOMPSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 96 JONATHAN LUCUS STREET CSB HE320E
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City | CHARLESTON
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State | SC
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Zip | 29425
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Country | US
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Telephone | 843-792-2528
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751461
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City | CHARLOTTE
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State | NC
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Zip | 28275-1461
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Country | US
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Telephone | 843-792-2528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | SC
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