Healthcare Provider Details

I. General information

NPI: 1174436133
Provider Name (Legal Business Name): BARTON AMBROSE COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BART COLLINS

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 843-222-1140
  • Fax:
Mailing address:
  • Phone: 843-222-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number285147
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: