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General NPI Number Information
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NPI Number | 1033153051
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Entity Type | Organization
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Legal Business Name | PALMETTO DISABLILITY EVALUATIONS, INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 535 WEST BUTLER RD SUITE C
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City | MAULDIN
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State | SC
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Zip | 29662
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Country | US
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Telephone | 864-277-9867
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Fax | 864-299-3442
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Provider Business Mailing Address
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Address Line | 535 W BUTLER RD SUITE C
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City | GREENVILLE
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State | SC
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Zip | 29607-4833
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Country | US
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Telephone | 864-277-9867
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Fax | 864-299-3442
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MRS. JANICE U FOWLER
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Credential |
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Telephone | 864-560-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | SC12306
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License Number State | SC
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