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General NPI Number Information
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NPI Number | 1306379474
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Entity Type | Individual
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Provider Name | SUSIE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 1001 HEALTH CENTER RD
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City | HENDERSON
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State | NC
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Zip | 27536-5482
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Country | US
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Telephone | 252-204-9866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1164
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City | HENDERSON
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State | NC
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Zip | 27536-1164
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Country | US
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Telephone | 252-204-9866
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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 | 347B00000X
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Taxonomy Name | Bus
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License Number | 81-2857034
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License Number State | NC
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