1720066574 NPI number — MR. THOMAS GREGG FOLSE MA, MAP

Table of content: MR. THOMAS GREGG FOLSE MA, MAP (NPI 1720066574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720066574 NPI number — MR. THOMAS GREGG FOLSE MA, MAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOLSE
Provider First Name:
THOMAS
Provider Middle Name:
GREGG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, MAP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720066574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6059 MOSSEY GROVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AWENDAW
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29429-6132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-928-3970
Provider Business Mailing Address Fax Number:
843-928-4076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1156 BOWMAN RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-991-0440
Provider Business Practice Location Address Fax Number:
843-928-4076
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  3362 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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