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General NPI Number Information
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NPI Number | 1699263335
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Entity Type | Organization
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Legal Business Name | PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 9 RICHLAND MEDICAL PARK DR STE 530
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City | COLUMBIA
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State | SC
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Zip | 29203-6870
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Country | US
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Telephone | 803-434-4603
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Fax | 803-434-3866
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Provider Business Mailing Address
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Address Line | PO BOX 743904
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City | ATLANTA
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State | GA
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Zip | 30374-3904
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Country | US
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Telephone | 803-296-7320
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Fax | 803-296-7330
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | WILLIAM D. ANDERSON III,
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Credential |
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Telephone | 803-545-5005
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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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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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