Healthcare Provider Details

I. General information

NPI: 1396191060
Provider Name (Legal Business Name): PALMETTO AREA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GREENVILLE DR SUITE B
WILLIAMSTON SC
29697-1130
US

IV. Provider business mailing address

900 GREENVILLE DR SUITE B
WILLIAMSTON SC
29697-1130
US

V. Phone/Fax

Practice location:
  • Phone: 864-840-9360
  • Fax: 864-847-5706
Mailing address:
  • Phone: 864-840-9360
  • Fax: 864-847-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberSC19015
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberSC1600
License Number StateSC

VIII. Authorized Official

Name: SHARON K DURHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-840-9360