Healthcare Provider Details

I. General information

NPI: 1629045505
Provider Name (Legal Business Name): ANTHONY BERTRAM ELKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MONTICELLO RD BLDG A, STE.3
COLUMBIA SC
29203-4156
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-0151
  • Fax: 803-691-1778
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20816
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20816
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: