Healthcare Provider Details

I. General information

NPI: 1558340786
Provider Name (Legal Business Name): PALMETTO FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N SUMTER ST SUITE 315
SUMTER SC
29150-4972
US

IV. Provider business mailing address

115 N SUMTER ST SUITE 315
SUMTER SC
29150-4972
US

V. Phone/Fax

Practice location:
  • Phone: 803-934-0810
  • Fax: 803-934-0809
Mailing address:
  • Phone: 803-934-0810
  • Fax: 803-934-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN RUSSELL FLEMING JR.
Title or Position: PHYSICIAN PARTNER
Credential: MD
Phone: 803-934-0810