Healthcare Provider Details

I. General information

NPI: 1407805963
Provider Name (Legal Business Name): JAMES BARTLETTE KEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 MEMORIAL DRIVE EXT SUITE C
GREER SC
29651-1155
US

IV. Provider business mailing address

554 MEMORIAL DRIVE EXT SUITE C
GREER SC
29651-1155
US

V. Phone/Fax

Practice location:
  • Phone: 864-879-3883
  • Fax: 864-848-3492
Mailing address:
  • Phone: 864-879-3883
  • Fax: 864-848-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number7450
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier074500
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: