Healthcare Provider Details

I. General information

NPI: 1083664395
Provider Name (Legal Business Name): PALMETTO BONE & JOINT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PHYSICIANS PARK DR
CLINTON SC
29325-7551
US

IV. Provider business mailing address

105 PHYSICIANS PARK DR
CLINTON SC
29325-7551
US

V. Phone/Fax

Practice location:
  • Phone: 864-938-0111
  • Fax: 864-938-0811
Mailing address:
  • Phone: 864-938-0111
  • Fax: 864-938-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP H MILNER
Title or Position: OWNER
Credential: D.O.
Phone: 864-938-0611