Provider Demographics
NPI:1790726461
Name:PARRISH, THOMAS EARL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EARL
Last Name:PARRISH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-719-6100
Mailing Address - Fax:336-719-2313
Practice Address - Street 1:865 W LAKE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2157
Practice Address - Country:US
Practice Address - Phone:336-719-6100
Practice Address - Fax:336-719-2313
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC11457207Q00000X
NC200601596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89066XNMedicaid
SC114575Medicaid
NC1431KOtherBCBS, NC
NCAP1696129OtherDEA
SCB918352843Medicare ID - Type Unspecified
NCAP1696129OtherDEA
NC89066XNMedicaid
NC2060576Medicare PIN