Healthcare Provider Details

I. General information

NPI: 1053396291
Provider Name (Legal Business Name): PALMETTO FAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GREENVILLE DR
WILLIAMSTON SC
29697-1130
US

IV. Provider business mailing address

900 GREENVILLE DR
WILLIAMSTON SC
29697-1130
US

V. Phone/Fax

Practice location:
  • Phone: 864-847-1818
  • Fax: 864-847-5706
Mailing address:
  • Phone: 864-847-1818
  • Fax: 864-847-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1600
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT M. DURHAM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 864-847-1818