Provider Demographics
NPI:1386897346
Name:WAY, THOMAS JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JUSTIN
Last Name:WAY
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 2087
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-2087
Mailing Address - Country:US
Mailing Address - Phone:864-716-7759
Mailing Address - Fax:764-716-7759
Practice Address - Street 1:1655 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2062
Practice Address - Country:US
Practice Address - Phone:864-716-7750
Practice Address - Fax:764-716-7759
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYN/A207Y00000X
SC35517207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01224267OtherRR MEDICARE
SC355172Medicaid
SC355172Medicaid