Provider Demographics
NPI:1275609489
Name:ANDERSON, THOMAS SHANNON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SHANNON
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749340
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3698
Practice Address - Country:US
Practice Address - Phone:843-849-1551
Practice Address - Fax:843-884-0629
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0090-01409207T00000X
SC25231207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0090-01409OtherNC MEDICAL BOARD
SCT81578Medicaid
NC0090-01409OtherNC MEDICAL BOARD
SCT81578Medicaid
NC2063014Medicare PIN