Healthcare Provider Details

I. General information

NPI: 1396543104
Provider Name (Legal Business Name): PALMETTO BONE AND JOINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WELLNESS BLVD SUITE 202
IRMO SC
29063
US

IV. Provider business mailing address

1 WELLNESS BLVD SUITE 202
IRMO SC
29063
US

V. Phone/Fax

Practice location:
  • Phone: 803-470-7040
  • Fax: 803-470-7050
Mailing address:
  • Phone: 803-470-7040
  • Fax: 803-470-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM OWENS JR.
Title or Position: OWNER
Credential: MD
Phone: 803-321-6254