Provider Demographics
NPI:1588870075
Name:LITTLE, GENERAL THEOPHILUS (MD)
Entity type:Individual
Prefix:DR
First Name:GENERAL
Middle Name:THEOPHILUS
Last Name:LITTLE
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 1:280 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5352
Mailing Address - Country:US
Mailing Address - Phone:843-722-6336
Mailing Address - Fax:
Practice Address - Street 1:280 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5352
Practice Address - Country:US
Practice Address - Phone:843-722-6336
Practice Address - Fax:843-722-6302
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine