Provider Demographics
NPI:1821060567
Name:CROCKER, THOMAS PRESSLEY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PRESSLEY
Last Name:CROCKER
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 1:404 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5803
Mailing Address - Country:US
Mailing Address - Phone:800-779-4858
Mailing Address - Fax:864-231-6448
Practice Address - Street 1:404 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5803
Practice Address - Country:US
Practice Address - Phone:800-779-4858
Practice Address - Fax:864-231-6448
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9773207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC097736Medicaid
GA000421154AMedicaid
E32546Medicare UPIN
SC097736Medicaid
GA000421154AMedicaid