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General NPI Number Information
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NPI Number | 1508897109
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Entity Type | Organization
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Legal Business Name | PALMETTO PEDIATRICS
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 2450 INDIA HOOK RD SUITE A
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City | ROCK HILL
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State | SC
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Zip | 29732-3270
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Country | US
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Telephone | 803-327-5772
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Fax | 803-327-9303
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Provider Business Mailing Address
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Address Line | PO BOX 60099
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City | CHARLOTTE
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State | NC
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Zip | 28260-0099
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Country | US
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Telephone | 803-327-5772
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Fax | 803-327-9303
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DANIEL L. WIENS
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Credential |
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Telephone | 704-355-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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