Provider Demographics
NPI:1083662910
Name:THOMAS, CHARLES B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:535 WEST BUTLER ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-4833
Practice Address - Country:US
Practice Address - Phone:864-277-9867
Practice Address - Fax:864-299-3442
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC12306207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123066Medicaid
SC123066Medicaid
SC5320120001Medicare PIN