Provider Demographics
NPI:1285202317
Name:FISHER, THOMAS JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:FISHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WH SMITH BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3788
Mailing Address - Country:US
Mailing Address - Phone:252-355-7301
Mailing Address - Fax:252-355-7301
Practice Address - Street 1:1011 WH SMITH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3788
Practice Address - Country:US
Practice Address - Phone:252-355-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT20290AOtherTN MEDICARE