Healthcare Provider Details

I. General information

NPI: 1477723724
Provider Name (Legal Business Name): PALMETTO PODIATRY GROUP OF ANDERSON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BEN CASEY DR SUITE 133
FORT MILL SC
29708-8561
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 803-396-8670
  • Fax: 803-396-8657
Mailing address:
  • Phone: 803-396-8670
  • Fax: 803-396-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES LEON ROSE
Title or Position: DPM/OWNER
Credential: DPM
Phone: 864-231-6395