Provider Demographics
NPI:1225193550
Name:THOMAS, STEPHANIE GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GAIL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E LUKE AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6834
Mailing Address - Country:US
Mailing Address - Phone:843-851-0079
Mailing Address - Fax:843-873-1002
Practice Address - Street 1:201 E LUKE AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6834
Practice Address - Country:US
Practice Address - Phone:843-851-0079
Practice Address - Fax:843-873-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC201732084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC201739Medicaid
SC201739Medicaid