Provider Demographics
NPI:1790763563
Name:NORRIS, G THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:G
Middle Name:THOMAS
Last Name:NORRIS
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 1:23 ROYALGATE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1315 ROBERTS STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-432-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-05-22
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-11
Provider Licenses
StateLicense IDTaxonomies
SC17366207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT14552Medicaid
SC080151770OtherMEDICARE RR ID#
SC080151770OtherMEDICARE RR ID#
3410Medicare PIN