Doctor Name: | PHYLLIS THOMAS |
NPI Number: | 1528485109 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 200 University Rdg Greenville, SC - 296013635 |
Business Phone Number: | 8643723163 |
Business Fax Number: | |
Mailing Address: | 200 University Rdg, GREENVILLE |
State: | SC |
Postal Code: | 296013635 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/21/2014 |
NPI Last Update Date: | 03/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |