Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 23586 | SC |
Y | 2080P0203X | Pediatric Critical Care Doctor | 23586 | SC |
N | 2080P0203X | Pediatric Critical Care Doctor | 99621 | FL |
NPI | 1134240104 |
---|---|
Provider Name | Thomas William Bannister |
First Address | Atlanta, GA 30384-2145 |
Second Address | Columbia, SC 29203-6859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 04/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
235862 | (05) | SC |