Healthcare Provider Details

I. General information

NPI: 1043260029
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 JOHN STREET
EASLEY SC
29640-1415
US

IV. Provider business mailing address

PO BOX 2089
EASLEY SC
29641-2089
US

V. Phone/Fax

Practice location:
  • Phone: 864-859-2220
  • Fax: 864-859-5744
Mailing address:
  • Phone: 864-855-5104
  • Fax: 864-859-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KENDALL DURHAM
Title or Position: PATIENT FINANCIAL MANAGER
Credential:
Phone: 864-855-5104