Provider Demographics
NPI:1871579573
Name:MCKINNEY, THORNTON STERLING JR (MD)
Entity type:Individual
Prefix:DR
First Name:THORNTON
Middle Name:STERLING
Last Name:MCKINNEY
Suffix:JR
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:PO BOX 8462
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-8462
Mailing Address - Country:US
Mailing Address - Phone:803-779-5356
Mailing Address - Fax:803-779-2135
Practice Address - Street 1:1919 GADSDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2346
Practice Address - Country:US
Practice Address - Phone:803-779-5356
Practice Address - Fax:803-779-2135
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00584322084P0804X
SC206862084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC206869Medicaid
SCAA2269Medicare UPIN