Provider Demographics
NPI:1083241772
Name:SENN, CALEB THOMAS (MD)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:THOMAS
Last Name:SENN
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 1:1634 NORWICH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6050
Mailing Address - Country:US
Mailing Address - Phone:803-530-2327
Mailing Address - Fax:
Practice Address - Street 1:113 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-269-3333
Practice Address - Fax:864-626-0757
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MST-4012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program