Provider Demographics
NPI:1609689876
Name:BOLTON, ERNEST ANTONIO
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:ANTONIO
Last Name:BOLTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EASTFERN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2403
Mailing Address - Country:US
Mailing Address - Phone:803-543-4977
Mailing Address - Fax:
Practice Address - Street 1:31 EASTFERN CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2403
Practice Address - Country:US
Practice Address - Phone:803-543-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator