Provider Demographics
NPI:1902566870
Name:THOMPKINS, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:THOMPKINS
Suffix:
Gender:M
Credentials:
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 1044
Mailing Address - Street 2:
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-1044
Mailing Address - Country:US
Mailing Address - Phone:702-626-4656
Mailing Address - Fax:
Practice Address - Street 1:209 SOUTH BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555-2955
Practice Address - Country:US
Practice Address - Phone:702-626-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker