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General NPI Number Information
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NPI Number | 1649196155
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Entity Type | Organization
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Legal Business Name | PALMETTO HEALTH GROUP
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 9521 VAUGHN RD STE MEDICAL
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City | PIKE ROAD
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State | AL
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Zip | 36064-2292
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Country | US
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Telephone | 814-490-7244
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Fax |
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Provider Business Mailing Address
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Address Line | 328 DANI LN
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City | MATHEWS
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State | AL
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Zip | 36052-4073
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Country | US
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Telephone | 814-490-7244
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CHRISTOPHER WAGUESPACK
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Credential | DO
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Telephone | 814-490-7244
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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 |
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License Number State |
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