Provider Demographics
NPI:1316692213
Name:BOATWRIGHT, STEPHEN COLE
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:COLE
Last Name:BOATWRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 KINGSBURY DR STE 6
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-7578
Mailing Address - Country:US
Mailing Address - Phone:803-607-8353
Mailing Address - Fax:
Practice Address - Street 1:220 KINGSBURY DR STE 6
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-7578
Practice Address - Country:US
Practice Address - Phone:803-607-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2472B0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472B0301XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherBiomedical Engineering