Healthcare Provider Details

I. General information

NPI: 1366974644
Provider Name (Legal Business Name): PALMETTO PRIMARY CARE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110B SPRINGHALL DR
GOOSE CREEK SC
29445-5335
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-2520
  • Fax: 843-553-4436
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-695-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39189
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39189
License Number StateSC

VIII. Authorized Official

Name: THOMAS BRANTLEY ARNAU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-695-6071