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General NPI Number Information
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NPI Number | 1285632638
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Entity Type | Individual
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Provider Name | THOMAS A PRIVETT MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 4811 AMBASSADOR CAFFERY PKWY STE 401B
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City | LAFAYETTE
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State | LA
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Zip | 70508-7265
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Country | US
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Telephone | 337-470-4978
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Fax | 337-470-4238
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Provider Business Mailing Address
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Address Line | 9330 MEDICAL PLAZA DR
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City | CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 843-847-3225
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Fax | 843-847-3247
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 23118
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 021911
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License Number State | LA
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