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General NPI Number Information
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NPI Number | 1124335898
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Entity Type | Organization
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Legal Business Name | PALMETTO INTERNAL MEDICINE & PRIMARY CARE, PA
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 300 W BUTLER RD
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City | MAULDIN
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State | SC
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Zip | 29662-2538
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Country | US
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Telephone | 864-277-8300
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Fax | 864-288-8722
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Provider Business Mailing Address
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Address Line | 300 W BUTLER RD
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City | MAULDIN
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State | SC
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Zip | 29662-2538
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Country | US
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Telephone | 864-277-8300
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Fax | 864-288-8722
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | BALA KRISHNIAH
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Credential | MD
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Telephone | 864-991-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 19652
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License Number State | SC
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