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General NPI Number Information
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NPI Number | 1285547455
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Entity Type | Organization
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Legal Business Name | PALMETTO PREVENTIVE
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 29 LEINBACH DR STE B1
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City | CHARLESTON
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State | SC
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Zip | 29407-7088
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Country | US
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Telephone | 854-238-3438
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Fax |
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Provider Business Mailing Address
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Address Line | 29 LEINBACH DR STE B1
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City | CHARLESTON
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State | SC
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Zip | 29407-7088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR.
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Name | LEISA STAFFORD
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Credential |
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Telephone | 854-238-3438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | NULL
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