Healthcare Provider Details

I. General information

NPI: 1285743278
Provider Name (Legal Business Name): JOHN H BARTLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST BIW 6033- NEONATOLOGY
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2331
  • Fax: 706-721-7531
Mailing address:
  • Phone: 706-721-2331
  • Fax: 706-721-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number047962
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: