Healthcare Provider Details

I. General information

NPI: 1508825340
Provider Name (Legal Business Name): PALMETTO FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BARTON CREEK COURT
COLUMBIA SC
29229-8027
US

IV. Provider business mailing address

109 BARTON CREEK COURT
COLUMBIA SC
29229-8027
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-2286
  • Fax: 803-343-2115
Mailing address:
  • Phone: 803-256-2286
  • Fax: 803-343-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number13700
License Number StateSC

VIII. Authorized Official

Name: DR. J. FRANK MARTIN JR.
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 803-256-2286