Healthcare Provider Details

I. General information

NPI: 1962767756
Provider Name (Legal Business Name): PALMETTO OB/GYN PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104B MORGAN PL
SUMMERVILLE SC
29485-8106
US

IV. Provider business mailing address

104B MORGAN PL
SUMMERVILLE SC
29485-8106
US

V. Phone/Fax

Practice location:
  • Phone: 843-851-3800
  • Fax: 843-851-7787
Mailing address:
  • Phone: 843-851-3800
  • Fax: 843-851-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: DEBORAH S. BREDESTEGE
Title or Position: OWNER
Credential: MD
Phone: 843-851-3800