Healthcare Provider Details

I. General information

NPI: 1144269929
Provider Name (Legal Business Name): PALMETTO PRIMARY CARE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 ISLAND PARK DR STE 200
DANIEL ISLAND SC
29492-8112
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-6402
  • Fax: 843-216-5068
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-569-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGP2906
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DR. THOMAS BRANTLEY ARNAU
Title or Position: PRESIDENT
Credential: MD
Phone: 843-572-7727