Healthcare Provider Details

I. General information

NPI: 1275822249
Provider Name (Legal Business Name): PALMETTO PSYCHIATRY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORT JACKSON BLVD STE 270
COLUMBIA SC
29209-1119
US

IV. Provider business mailing address

4500 FORT JACKSON BLVD STE 270
COLUMBIA SC
29209-1119
US

V. Phone/Fax

Practice location:
  • Phone: 803-764-3555
  • Fax: 803-764-4418
Mailing address:
  • Phone: 803-764-3555
  • Fax: 803-764-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE RALEY
Title or Position: OWNER
Credential: M.D.
Phone: 803-764-3555