Provider Demographics
NPI:1912940586
Name:GETTYS, JAMES BOULWARE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BOULWARE
Last Name:GETTYS
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:807 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1551
Practice Address - Country:US
Practice Address - Phone:864-455-9150
Practice Address - Fax:864-455-9236
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4366991OtherAETNA
SC237041Medicaid
SC571004971008OtherBCBS OF SC
SC9541437OtherCIGNA
SCP00233374OtherRR MEDICARE
SCH94341Medicare UPIN
SCH943417951Medicare PIN