Provider Demographics
NPI:1851394597
Name:THOMPSON, CHARLES ARMISTEAD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ARMISTEAD
Last Name:THOMPSON
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:PO BOX 4145
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-4145
Mailing Address - Country:US
Mailing Address - Phone:864-540-8025
Mailing Address - Fax:864-540-8027
Practice Address - Street 1:1214 N FANT ST STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4822
Practice Address - Country:US
Practice Address - Phone:864-540-8025
Practice Address - Fax:864-540-8027
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17521207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC175214Medicaid
SC8607OtherMEDICARE GROUP NUMBER
GA701180308CMedicaid
SCP00944916OtherRR MEDICIARE
GA701180308CMedicaid
SCGP3212Medicaid
SCC226347111Medicare PIN
GA701180308CMedicaid
SC175214Medicaid