Healthcare Provider Details

I. General information

NPI: 1649196155
Provider Name (Legal Business Name): PALMETTO HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 VAUGHN RD STE MEDICAL
PIKE ROAD AL
36064-2292
US

IV. Provider business mailing address

328 DANI LN
MATHEWS AL
36052-4073
US

V. Phone/Fax

Practice location:
  • Phone: 814-490-7244
  • Fax:
Mailing address:
  • Phone: 814-490-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER WAGUESPACK
Title or Position: PHYSICIAN
Credential: DO
Phone: 814-490-7244