MEDICARE: PALMETTO IMAGING, LLC

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	2085R0202X	Diagnostic Radiology Physician		SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470000944	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	571103875	OTHER	SC	BCBS

General Provider Information

NPI Number	:	1871551390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO IMAGING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 933548
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-3548
Country	:	US
Telephone Number	:	770-300-0101
Fax Number	:	770-300-0429

Provider Business Practice Location Address
First Line	:	1331 LADY STREET
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3319
Country	:	US
Telephone Number	:	770-300-0101
Fax Number	:	770-300-0429

Authorized Official
Title or Position	:	SVP FINANCE AND REVENUE CYCLE
Name	:	MR. GEOFFREY K. GARDNER
Credential	:
Telephone Number	:	678-992-7255

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/19/2024

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Directions to “PALMETTO IMAGING, LLC ” Practice Location

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