Healthcare Provider Details

I. General information

NPI: 1891754651
Provider Name (Legal Business Name): PALMETTO ALLERGY & ASTHMA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STE 430 9 RICHLAND MEDICAL PK
COLUMBIA SC
29203-6870
US

IV. Provider business mailing address

STE 430 9 RICHLAND MEDICAL PK
COLUMBIA SC
29203-6870
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-9435
  • Fax: 803-765-2446
Mailing address:
  • Phone: 803-765-9435
  • Fax: 803-765-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA S HUTTO
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 803-765-9435