=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265895320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLA THOMAS, DC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2016
-----------------------------------------------------
Last Update Date | 04/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 655 WESTFIELD CT
-----------------------------------------------------
City | SUMTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29154-8811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-266-3222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 655 WESTFIELD CT
-----------------------------------------------------
City | SUMTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29154-8811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CARLA THOMAS
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 864-266-3222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 2916
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------