Healthcare Provider Details

I. General information

NPI: 1316058837
Provider Name (Legal Business Name): BARTO PAUL KELLETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/21/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RELIANT GERIATRICS 3523 PELHAM RD, SUITE C
GREENVILLE SC
29615-4191
US

IV. Provider business mailing address

RELIANT GERIATRICS P.O. BOX 14611
GREENVILLE SC
29610-4611
US

V. Phone/Fax

Practice location:
  • Phone: 864-306-0966
  • Fax: 864-306-2544
Mailing address:
  • Phone: 864-306-0966
  • Fax: 864-306-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number8851
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8851
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: