Healthcare Provider Details

I. General information

NPI: 1467526459
Provider Name (Legal Business Name): PALMETTO ENT CONSULTANTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 DEVINE ST STE 101
COLUMBIA SC
29205-2511
US

IV. Provider business mailing address

2801 DEVINE ST STE 101
COLUMBIA SC
29205-2511
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-7076
  • Fax: 803-256-0961
Mailing address:
  • Phone: 803-256-7076
  • Fax: 803-256-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE A DRAFFIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 803-256-7076