Provider Demographics
NPI:1053335281
Name:THOMBS, EVERETTE B SR (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETTE
Middle Name:B
Last Name:THOMBS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-0801
Mailing Address - Country:US
Mailing Address - Phone:704-739-9586
Mailing Address - Fax:704-739-6119
Practice Address - Street 1:711 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2711
Practice Address - Country:US
Practice Address - Phone:704-739-9586
Practice Address - Fax:704-739-6119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982776Medicaid
NC8982776Medicaid
NC2319809Medicare ID - Type Unspecified