John Bruce Etheridge, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

19936 Issued in SC

Practice address

1320 Ribaut Rd
Port Royal, SC 29935-1118

Phone

(843) 986-0900

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Palmetto Pediatrics, PA

  • Pediatrics Physician
  • North Charleston, SC
  • NPI 1861560765
  NPD (past)
• Trident Medical Center, LLC

  dba HCA Healthcare Trident Hospital

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1366496937
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1861586414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 OKATIE HWY",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 RIBAUT RD",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299351118",
            "telephone_number": "843-986-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2781 Tricom Street",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294069170",
            "country_code": "US",
            "telephone_number": "843-797-5600",
            "fax_number": "843-572-4872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "JOHN",
        "middle_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "19936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199369",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosalind Dawson, M.D.
• Brooke Ashley Dean, PH. D.
• Patricia A Dean, M.ED.
• Doctors Care SC, PA (Doctors Care Beaufort)
• Alexandra L Edenfield, PA
• Richard H Fitzgerald, M.D.
• Arianne M Fredrickson, PA-C
• Fresenius Medical Care Beaufort County, LLC (FMC Dialysis Services Low Country Dialysis)
• Genesis Eldercare Rehabilitation Services LLC (Genesis Rehabilitation Services)
• Ashton Marie Giammona, PA-C

• Pediatrics Physician in Port Royal, SC
• Providers in Port Royal, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.