Provider Demographics
NPI:1528030863
Name:THOMAS, CHAD ALEXANDER (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALEXANDER
Last Name:THOMAS
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-376-0670
Mailing Address - Fax:843-376-0669
Practice Address - Street 1:5500 FRONT ST # 260
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7735
Practice Address - Country:US
Practice Address - Phone:843-376-0670
Practice Address - Fax:843-376-0669
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1047PAMedicaid