MEDICARE: PALMETTO HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144467051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 402145
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2145
Country	:	US
Telephone Number	:	803-296-7305
Fax Number	:	803-296-7329

Provider Business Practice Location Address
First Line	:	1850 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2627
Country	:	US
Telephone Number	:	803-256-3400
Fax Number	:	803-256-2039

Authorized Official
Title or Position	:	DIRECTOR BUSINESS DEV. FINANCE
Name	:	MR. DARRELL C. COVEN
Credential	:
Telephone Number	:	803-296-7301

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	11/14/2012

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Directions to “PALMETTO HEALTH ” Practice Location

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