Provider Demographics
NPI:1952330011
Name:BETHI, NAVEEN R (MD)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:R
Last Name:BETHI
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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0721
Mailing Address - Country:US
Mailing Address - Phone:864-299-1990
Mailing Address - Fax:864-299-9123
Practice Address - Street 1:545W BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4833
Practice Address - Country:US
Practice Address - Phone:864-299-1990
Practice Address - Fax:864-299-9123
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT55491Medicaid
SCT55491Medicaid
SC7761Medicare PIN