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General NPI Number Information
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NPI Number | 1053396291
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Entity Type | Organization
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Legal Business Name | PALMETTO FAMILY MEDICAL GROUP
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 900 GREENVILLE DR
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City | WILLIAMSTON
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State | SC
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Zip | 29697-1130
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Country | US
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Telephone | 864-847-1818
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Fax | 864-847-5706
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Provider Business Mailing Address
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Address Line | 900 GREENVILLE DR
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City | WILLIAMSTON
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State | SC
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Zip | 29697-1130
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Country | US
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Telephone | 864-847-1818
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Fax | 864-847-5706
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT M. DURHAM
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Credential | D.C.
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Telephone | 864-847-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1600
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License Number State | SC
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