Healthcare Provider Details

I. General information

NPI: 1316681562
Provider Name (Legal Business Name): PALMETTO INFUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 BRECKINRIDGE BLVD STE 126
DULUTH GA
30096-4989
US

IV. Provider business mailing address

PO BOX 538476
ATLANTA GA
30353-8476
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone: 843-314-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GLENN EUGENE RICHMOND
Title or Position: DIRECTOR
Credential:
Phone: 843-314-2060