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General NPI Number Information
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NPI Number | 1689890311
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Entity Type | Organization
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Legal Business Name | PALMETTO HEALTH
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 4311 HARD SCRABBLE RD
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City | COLUMBIA
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State | SC
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Zip | 29229-9422
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Country | US
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Telephone | 803-296-7313
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Fax | 803-296-7330
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Provider Business Mailing Address
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Address Line | PO BOX 402145
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City | ATLANTA
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State | GA
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Zip | 30384-2145
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Country | US
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Telephone | 803-788-6570
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Fax | 803-788-6574
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEV., FINANCE
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Name | MR. DARRELL COVEN
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Credential |
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Telephone | 803-296-7301
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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 | SC
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