MARK EDWARD BOULDEN JR. ATC
NPI 1053764977
Specialist/Technologist - Athletic Trainer in Georgetown, SC

Active since July 15, 2016
2185 N FRASER ST, GEORGETOWN, SC 29440(843) 527-1800(843) 527-6528 Get Directions Write a Review

NPPES record last updated: July 15, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Mark Edward Boulden Jr. Atc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK EDWARD BOULDEN JR. ATC (NPI 1053764977) is an individual athletic trainer provider in Georgetown, South Carolina, licensed in South Carolina (1667) and active in the NPI registry since July 2016.Information from the official NPPES registry record, last updated July 15, 2016.

NPPES Registry Identity

NPI1053764977
Entity TypeIndividualMale
Provider Legal NameMARK EDWARD BOULDEN JR.Credential: ATC
Location Address2185 N FRASER STGeorgetown, SC 29440-6418
Mailing Address2185 N Fraser StGeorgetown, SC 29440-6418 · (843) 527-1800 · Fax (843) 527-6528
Fax(843) 527-6528
Sole ProprietorNo
Enumeration DateJuly 15, 2016
NPI 1053764977 is a valid, active identifier and passes the ISO check-digit test. How NPI validation works

Primary Specialty

Specialist/Technologist · Athletic Trainer

Taxonomy 2255A2300X · Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Licensed in SC · 1667

Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment,… Show more

2185 N FRASER ST, Georgetown, SC 29440

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Other Providers at the Same Location


The following 7 providers are registered at the same or a nearby location.

Orthopaedic Surgery
2185 N FRASER ST
GEORGETOWN, SC 29440
Physician Assistant
2185 N FRASER ST
GEORGETOWN, SC 29440
Orthopaedic Surgery
2185 N FRASER ST
GEORGETOWN, SC 29440
Orthopaedic Surgery
2185 N FRASER ST
GEORGETOWN, SC 29440
Physician Assistant
2185 N FRASER ST
GEORGETOWN, SC 29440
Orthopaedic Surgery
2185 N FRASER ST
GEORGETOWN, SC 29440
Orthopaedic Surgery (Sports Medicine)
2185 N FRASER ST
GEORGETOWN, SC 29440

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1053764977, enumerated as an "individual" on July 15, 2016.

The provider is located at 2185 N FRASER ST GEORGETOWN, SC 29440 and the phone number is (843) 527-1800.

Specialist/Technologist with taxonomy code 2255A2300X and a focus in Athletic Trainer.