Healthcare Provider Details

I. General information

NPI: 1043316987
Provider Name (Legal Business Name): PALMETTO PODIATRY GROUP OF ANDERSON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 - B HWY 81 NORTH
ANDERSON SC
29621-4819
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 864-231-6395
  • Fax: 864-231-6520
Mailing address:
  • Phone: 864-231-6395
  • Fax: 864-231-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES L ROSE
Title or Position: PRESIDENT
Credential: DPM
Phone: 864-231-6395