Healthcare Provider Details

I. General information

NPI: 1316925787
Provider Name (Legal Business Name): SANTA JOAN BARTHOLOMEW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. SANTA JOAN JOHNSTON

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-5871
  • Fax: 252-744-5759
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101049567
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0101049567
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2012-02313
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01062804A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: