Healthcare Provider Details

I. General information

NPI: 1457433278
Provider Name (Legal Business Name): PALMETTO DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3574 SUNSET BLVD
WEST COLUMBIA SC
29169-3044
US

IV. Provider business mailing address

3574 SUNSET BLVD
WEST COLUMBIA SC
29169-3044
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-2500
  • Fax: 803-796-4378
Mailing address:
  • Phone: 803-796-2500
  • Fax: 803-796-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA M FLEMING
Title or Position: BILLING COORDINATOR
Credential:
Phone: 803-796-2500