Provider Demographics
NPI:1780679241
Name:THOMAS, JEFFREY BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BERNARD
Last Name:THOMAS
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 1:111 TIFTON DR E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-3207
Mailing Address - Country:US
Mailing Address - Phone:864-223-8090
Mailing Address - Fax:
Practice Address - Street 1:160 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3808
Practice Address - Country:US
Practice Address - Phone:864-223-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29435208600000X
TN34540208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery