Healthcare Provider Details

I. General information

NPI: 1992726269
Provider Name (Legal Business Name): THE PALMETTO SKIN AND LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 HEALTH CARE DR
ROCK HILL SC
29732-3858
US

IV. Provider business mailing address

1563 HEALTH CARE DR
ROCK HILL SC
29732-3858
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-6030
  • Fax: 803-329-6035
Mailing address:
  • Phone: 803-329-6030
  • Fax: 803-329-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD E WHITE
Title or Position: OWNER PARTNER
Credential: MD
Phone: 803-329-6030