Healthcare Provider Details

I. General information

NPI: 1689465270
Provider Name (Legal Business Name): JACOB BOATRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH HEALTH CLINIC MARINE CORPS AIR STATION PO BOX 555020
BEAUFORT SC
29904
US

IV. Provider business mailing address

1717 COUNTY ROAD 220 APT 2505
FLEMING ISLAND FL
32003-7992
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-7424
  • Fax:
Mailing address:
  • Phone: 385-251-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101290659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: