Healthcare Provider Details

I. General information

NPI: 1508830217
Provider Name (Legal Business Name): PALMETTO PRIMARY CARE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FUNK AVE
SAINT STEPHEN SC
29479-3383
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-567-3206
  • Fax: 843-567-3287
Mailing address:
  • Phone: 843-572-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13550
License Number StateSC

VIII. Authorized Official

Name: TERRY CUNNINGHAM
Title or Position: CEO
Credential:
Phone: 843-572-7727