Provider Demographics
NPI:1497918296
Name:THURSTON, BRIAN CALDWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CALDWELL
Last Name:THURSTON
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 NORTH CHURCH STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3077
Practice Address - Country:US
Practice Address - Phone:864-560-1576
Practice Address - Fax:864-560-1590
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL31160208600000X
TXP65352086S0102X, 2086S0127X
SC31160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01367357OtherRAILROAD MEDICARE
SC311601Medicaid
SCSC33393365Medicare PIN