Provider Demographics
NPI:1093814055
Name:FAMILY PHYSICIANS NORTH
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-279-1412
Mailing Address - Street 1:309 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3800
Mailing Address - Country:US
Mailing Address - Phone:803-279-1412
Mailing Address - Fax:803-279-2858
Practice Address - Street 1:309 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3800
Practice Address - Country:US
Practice Address - Phone:803-279-1412
Practice Address - Fax:803-279-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC8076207Q00000X
SC12890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2559Medicaid
SC6376Medicare PIN