Healthcare Provider Details

I. General information

NPI: 1508809906
Provider Name (Legal Business Name): PALMETTO ENDOCRINE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 VILLAGE PARK DR
ORANGEBURG SC
29118-2401
US

IV. Provider business mailing address

1709 VILLAGE PARK DR
ORANGEBURG SC
29118-2401
US

V. Phone/Fax

Practice location:
  • Phone: 803-515-9744
  • Fax: 803-515-9733
Mailing address:
  • Phone: 803-515-9744
  • Fax: 803-515-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN A MYERS
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 803-515-9744