Provider Demographics
NPI:1396286878
Name:J. WILLIAM THURMOND III, MD LLC
Entity type:Organization
Organization Name:J. WILLIAM THURMOND III, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-279-4561
Mailing Address - Street 1:509 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3108
Mailing Address - Country:US
Mailing Address - Phone:803-426-1994
Mailing Address - Fax:706-855-6658
Practice Address - Street 1:509 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841
Practice Address - Country:US
Practice Address - Phone:803-426-1994
Practice Address - Fax:706-855-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty