Provider Demographics
NPI:1962438804
Name:THURMOND, JOHN W III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:THURMOND
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:803-279-4561
Mailing Address - Fax:803-278-5109
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:803-279-4561
Practice Address - Fax:803-278-5109
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080762Medicaid
SC080762Medicaid