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General NPI Number Information
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NPI Number | 1912062142
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Entity Type | Individual
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Provider Name | DONALD ELMER BARTLETT JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 2021 N MYRTLE POINT BLVD STE 101
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2224
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Country | US
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Telephone | 843-366-2900
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Fax | 843-366-2450
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Provider Business Mailing Address
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Address Line | 506 E CHEVES ST STE 202
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City | FLORENCE
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State | SC
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Zip | 29506-2616
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Country | US
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Telephone | 843-366-2900
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Fax | 843-366-2450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 0101039372
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 91744
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License Number State | SC
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