Provider Demographics
NPI:1568464469
Name:HART, JANICE L (DO)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442
Mailing Address - Country:US
Mailing Address - Phone:843-527-7058
Mailing Address - Fax:843-546-7601
Practice Address - Street 1:9820 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4013
Practice Address - Country:US
Practice Address - Phone:843-497-2273
Practice Address - Fax:843-215-2276
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0229207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC002295Medicaid
SCQ24671Medicare PIN