Healthcare Provider Details

I. General information

NPI: 1124226006
Provider Name (Legal Business Name): DOUGLAS HAROLD GLEATON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ASHLEY RIVER RD
CHARLESTON SC
29407-5315
US

IV. Provider business mailing address

PO BOX 13955
CHARLESTON SC
29422-3955
US

V. Phone/Fax

Practice location:
  • Phone: 854-429-1175
  • Fax: 843-695-9467
Mailing address:
  • Phone: 843-225-8320
  • Fax: 843-225-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30062
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: