Healthcare Provider Details

I. General information

NPI: 1912062142
Provider Name (Legal Business Name): DONALD ELMER BARTLETT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N MYRTLE POINT BLVD STE 101
NORTH MYRTLE BEACH SC
29582-2224
US

IV. Provider business mailing address

506 E CHEVES ST STE 202
FLORENCE SC
29506-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-366-2900
  • Fax: 843-366-2450
Mailing address:
  • Phone: 843-366-2900
  • Fax: 843-366-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101039372
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number91744
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: