Provider Demographics
NPI:1427001452
Name:EUSTIS, THOMAS CHADWICK (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHADWICK
Last Name:EUSTIS
Suffix:
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 1:2727 PACES FERRY ROAD
Mailing Address - Street 2:SUITE 1-1100 (ATTENTION: DENISE)
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336
Mailing Address - Country:US
Mailing Address - Phone:470-271-3421
Mailing Address - Fax:
Practice Address - Street 1:1240 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-856-6380
Practice Address - Fax:877-929-2506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL32407207RG0100X, 208600000X
GA063583208600000X
KY36338208600000X
SC32407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC324072Medicaid
KY6403343Medicaid
SCP00918204OtherRAILROAD MEDICARE ID-RSFPN
SC324072Medicaid
KY6403343Medicaid
KY1909201Medicare PIN