Healthcare Provider Details

I. General information

NPI: 1477248490
Provider Name (Legal Business Name): OGLESBY BARRETT III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 MYRTLE TRACE DR
CONWAY SC
29526-8945
US

IV. Provider business mailing address

4101 CHARLOTTE AVE STE F185
NASHVILLE TN
37209-4066
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-8079
  • Fax:
Mailing address:
  • Phone: 877-206-0146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number810
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number810
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: