Healthcare Provider Details

I. General information

NPI: 1467629261
Provider Name (Legal Business Name): PALMETTO MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 EDGEWATER CORPORATE PKWY SUITE 101
INDIAN LAND SC
29707-7177
US

IV. Provider business mailing address

1040 EDGEWATER CORPORATE PKWY SUITE 101
INDIAN LAND SC
29707-7177
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-7007
  • Fax:
Mailing address:
  • Phone: 803-548-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIT G SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-548-7007