Healthcare Provider Details

I. General information

NPI: 1902097629
Provider Name (Legal Business Name): PALMETTO OB/GYN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 TAYLOR ST SUITE 5-F
COLUMBIA SC
29201-2923
US

IV. Provider business mailing address

1333 TAYLOR ST SUITE 5-F
COLUMBIA SC
29201-2923
US

V. Phone/Fax

Practice location:
  • Phone: 803-733-9598
  • Fax: 803-799-3771
Mailing address:
  • Phone: 803-733-9598
  • Fax: 803-799-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3304
License Number StateSC

VIII. Authorized Official

Name: MRS. PAMELA RENA ALLIGOOD
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: RN,MSN, CNM
Phone: 803-733-9598