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NPI Code Detail

MEDICARE: DR. KELLY STEPHENSON BARTH DO

MEDICARE: DR. KELLY STEPHENSON BARTH DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RA0401XAddiction Medicine (Internal Medicine) Physician757SC

General Provider Information

NPI Number : 1366526030
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY STEPHENSON BARTH DO
Provider Business Mailing Address
First Line : 1026 DOMINION DR
Second Line :
City : HANAHAN
State : SC
Zip : 29410-2408
Country : US
Telephone Number : 267-438-9826
Fax Number :
Provider Business Practice Location Address
First Line : 67 PRESIDENT ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-5712
Country : US
Telephone Number : 843-792-9888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/15/2008

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