Healthcare Provider Details

I. General information

NPI: 1659430726
Provider Name (Legal Business Name): PALMETTO PULMONARY MEDICINE. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 RIBAUT RD SUITE 340
BEAUFORT SC
29902-5472
US

IV. Provider business mailing address

989 RIBAUT RD SUITE 340
BEAUFORT SC
29902-5472
US

V. Phone/Fax

Practice location:
  • Phone: 843-521-8484
  • Fax: 843-521-8485
Mailing address:
  • Phone: 843-521-8484
  • Fax: 843-521-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PETER NICHOLAS MANOS
Title or Position: OWNER
Credential: M.D.
Phone: 843-521-8484