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NPI Code Detail

MEDICARE: MATTIE THOMAS

MEDICARE: MATTIE THOMAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianLL97108SC

General Provider Information

NPI Number : 1730014754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTIE THOMAS
Provider Business Mailing Address
First Line : 169 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 171 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8908
Country : US
Telephone Number : 843-792-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2026
Last Update Date : 06/13/2026

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Directions to “ MATTIE THOMAS ” Practice Location

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