Provider Demographics
NPI:1790040491
Name:MCCANTS, THOMAS T
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:MCCANTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 DIANE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6607
Mailing Address - Country:US
Mailing Address - Phone:803-772-1840
Mailing Address - Fax:803-772-1840
Practice Address - Street 1:2801 DIANE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6607
Practice Address - Country:US
Practice Address - Phone:803-772-1840
Practice Address - Fax:803-772-1840
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57-1101514171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor