Provider Demographics
NPI:1043973977
Name:THOMAS, ALICIA JOHNSON (MSN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:JOHNSON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 SOUTHBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5822
Mailing Address - Country:US
Mailing Address - Phone:843-319-8642
Mailing Address - Fax:
Practice Address - Street 1:2215 W PALMETTO ST STE F
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3971
Practice Address - Country:US
Practice Address - Phone:843-407-4046
Practice Address - Fax:843-407-4046
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC55482163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator