MEDICARE: SAVANNAH THAMES APRN, PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26743	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26743	OTHER	SC	SC APRN LICENSE

General Provider Information

NPI Number	:	1740997956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH THAMES APRN, PMHNP

Provider Business Mailing Address
First Line	:	1016 2ND AVE N STE 205
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3288
Country	:	US
Telephone Number	:	843-491-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 2ND AVE N STE 205
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3288
Country	:	US
Telephone Number	:	843-491-3344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	10/28/2022

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