Healthcare Provider Details

I. General information

NPI: 1114985397
Provider Name (Legal Business Name): PALMETTO IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900A 21ST AVE NORTH
MYRTLE BEACH SC
29577-7483
US

IV. Provider business mailing address

PO BOX 933548
ATLANTA GA
31193-3548
US

V. Phone/Fax

Practice location:
  • Phone: 770-300-0101
  • Fax: 770-300-0429
Mailing address:
  • Phone: 770-300-0101
  • Fax: 770-300-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DANIEL J SCHAEFER
Title or Position: COO
Credential:
Phone: 770-300-0101