Healthcare Provider Details

I. General information

NPI: 1104472109
Provider Name (Legal Business Name): PALMETTO BONE AND JOINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PALMETTO BONE AND JOINT 2605 KINARD ST SUITE 105
NEWBERRY SC
29108
US

IV. Provider business mailing address

2605 KINARD ST
NEWBERRY SC
29108
US

V. Phone/Fax

Practice location:
  • Phone: 803-321-6254
  • Fax: 803-321-6259
Mailing address:
  • Phone: 803-321-6254
  • Fax: 803-321-6259

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 Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP H. MILNER
Title or Position: PHYSICIAN
Credential: DO
Phone: 864-833-3046