MARK EDWARD BOULDEN JR. (NPI# 1053764977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053764977 |
| Entity Type | Individual |
| Full Name | MARK EDWARD BOULDEN JR. |
| Credential | ATC |
| Practice Address |
2185 N Fraser St Georgetown SC 29440-6418 |
| Practice Telephone | 8435271800 |
| Practice Fax Number | 8435276528 |
| Mailing Telephone | 8435271800 |
| Mailing Fax Number | 8435276528 |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
1667 | SC | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
2185 N FRASER ST |
| City | GEORGETOWN |
| State | SC |
| Zip Code | 29440-6418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518965375 | Mark Joseph Galloway | Physician Assistant | 2185 N Fraser St, Georgetown, SC 29440-6418 | 2005-07-14 |
| 1699311019 | Brittany Mccall Dieffenbach | Physician Assistant | 2185 N Fraser St, Georgetown, SC 29440-6418 | 2019-11-20 |
| 1912401399 | Georgetown Physician Associates, LLC | Orthopaedic Surgery | 2185 N Fraser St, Georgetown, SC 29440 | 2018-03-21 |
| 1043574882 | Earl James Han | Orthopaedic Surgery | 2185 N Fraser St, Georgetown, SC 29440-6418 | 2012-06-26 |
| 1548549017 | Georgetown Orthopaedics, LLC | Orthopaedic Surgery | 2185 N Fraser St, Georgetown, SC 29440-6418 | 2011-08-15 |
| 1922194257 | Mark Andrew Rowley | Orthopaedic Surgery | 2185 N Fraser St, Georgetown, SC 29440 | 2006-10-05 |
| 1689647588 | Mark E Triana | Orthopaedic Surgery | 2185 N Fraser St, Georgetown, SC 29440-6418 | 2006-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003288788 | Bartou Wilson | Pharmacist | 513 Rosemont St, Georgetown, SC 29440 | 2015-10-21 |
| 1538557780 | Sc Pain and Spine Specialist | Pain Medicine | 230 S Fraser Street, Georgetown, SC 29440 | 2014-12-22 |
| 1326393745 | Rose Carpenzano | Social Worker | 525 Lafayette Circle, Waccamaw Center for Mental Health, Georgetown, SC 29440 | 2012-07-23 |
| 1942575451 | Surgical Specialists of Waccamaw, LLC | Surgery | 4367 Riverwood Drive, Suite 130, Murrells Inlet, SC 29440 | 2012-03-16 |
| 1619296654 | Lisa Marie Holmes | Durable Medical Equipment & Medical Supplies | 1263 N. Frazer St., Georgetown, SC 29440 | 2010-05-28 |
| 1104156892 | Georgetown Anesthesia Consultants, PC | Anesthesiology | 606 Blackriver Road, Georgetown, SC 29440 | 2010-01-04 |
| 1306018999 | Heather Denise Sharpe | Pharmacist | 810 Elizabeth Street, Georgetown, SC 29440 | 2008-03-24 |
| 1083882054 | Advanced Chiropractic Center | Chiropractor | 705 North Fraser Street, Advanced Chiropractic Center, Georgetown, SC 29440 | 2008-02-13 |
| 1295922284 | Georgetown Memorial Hospital | Clinic/Center | 2361 North Frasier Street, Georgetown, SC 29440 | 2007-10-03 |
| 1114110863 | Thomas Clifford Rowland Jr. | Obstetrics & Gynecology | 74 Swan Point Trail, Georgetown, SC 29440 | 2007-08-24 |
| Find all providers in zip 29440 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306457577 | Katherine Lynn Helly | Specialist/Technologist | 108 Crawford Dr, Georgetown, KY 40324 | 2020-08-12 |
| 1083231310 | Lindsay Perry | Specialist/Technologist | 129 Wellesly Ave, Georgetown, KY 40324-8091 | 2020-07-02 |
| 1629690771 | Chad Patrick Hennessey | Specialist/Technologist | 2211 N Austin Ave, Georgetown, TX 78626-4514 | 2020-05-12 |
| 1619502390 | Michaela Teresa Etheridge | Specialist/Technologist | 2500 Anthuan Maybank St, Georgetown, SC 29440-2520 | 2020-03-03 |
| 1073150272 | Elissa Roblero | Specialist/Technologist | 22161 Rust Rd, Georgetown, DE 19947-5560 | 2019-12-06 |
| 1659855989 | Alexandra Adams | Specialist/Technologist | 202 Shady Elm, Georgetown, TX 78633-2037 | 2018-09-22 |
| 1992207492 | Xandrea Elizabeth Lara | Specialist/Technologist | 900 Jasmine Trl, Georgetown, TX 78626-4779 | 2018-03-01 |
| 1316479264 | Sabrina Queen | Specialist/Technologist | 105 N Austin Ave, Apt #9106, Georgetown, TX 78626-4239 | 2017-03-30 |
| 1548701204 | Johanna Puetz | Specialist/Technologist | 412 Derby Ln, Georgetown, TX 78626-6322 | 2017-03-14 |
| 1225586241 | Raymond J Albensi | Specialist/Technologist | 685 Anderson Rd, Georgetown, KY 40324-9278 | 2016-09-19 |
| Find all providers in GEORGETOWN | ||||
| City | GEORGETOWN |
| Zip Code | 29440 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.