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General NPI Number Information
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NPI Number | 1184884678
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Entity Type | Organization
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Legal Business Name | PALMETTO HEALTH COUNCIL INC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 643 MAIN ST
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City | PALMETTO
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State | GA
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Zip | 30268-1138
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Country | US
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Telephone | 770-463-4644
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Fax | 770-463-9885
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Provider Business Mailing Address
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Address Line | 643 MAIN ST
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City | PALMETTO
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State | GA
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Zip | 30268-1138
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Country | US
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Telephone | 404-929-8824
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Fax | 404-929-9769
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. TARA BROWN
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Credential | DMD
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Telephone | 404-929-8824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H800040
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | H800040
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License Number State | GA
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