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General NPI Number Information
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NPI Number | 1619167533
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Entity Type | Organization
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Legal Business Name | THRASHER PSYCHOTHERAPEUTICS PA
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 1113 48TH AVE N SUITE 117
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5441
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Country | US
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Telephone | 843-449-7105
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Fax | 843-449-5090
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Provider Business Mailing Address
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Address Line | 1113 48TH AVE N SUITE 117
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5441
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Country | US
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Telephone | 843-449-7105
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Fax | 843-449-5090
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES WINFIELD THRASHER JR.
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Credential | M.D.
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Telephone | 843-449-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12036
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License Number State | SC
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