Provider Demographics
NPI:1629418074
Name:BOLTON, SHANTELE HINTON (MD)
Entity Type:Individual
Prefix:
First Name:SHANTELE
Middle Name:HINTON
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 U S HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8569
Mailing Address - Country:US
Mailing Address - Phone:601-268-9393
Mailing Address - Fax:601-268-9559
Practice Address - Street 1:6524 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8569
Practice Address - Country:US
Practice Address - Phone:601-268-9393
Practice Address - Fax:601-268-9559
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24981207V00000X
MST-2676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology