Provider Demographics
NPI:1861564627
Name:BARTON, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:BARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:255 ENTERPRISE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6300
Practice Address - Country:US
Practice Address - Phone:864-454-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146504Medicaid
NC890659KMedicaid
SCP00801498OtherRR MEDICARE
NC890659KMedicaid
SCC367167951Medicare PIN