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General NPI Number Information
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NPI Number | 1811087539
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Entity Type | Organization
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Legal Business Name | PALMETTO KIDNEY AND HYPERTENSION LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 2093 HENRY TECKLENBURG DRIVE SUITE 307
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City | CHARLESTON
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State | SC
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Zip | 29414-5741
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Country | US
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Telephone | 843-573-0858
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Fax | 843-573-0859
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Provider Business Mailing Address
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Address Line | 2093 HENRY TECKLENBURG DRIVE STE 307
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City | CHARLESTON
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State | SC
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Zip | 29414-5743
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Country | US
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Telephone | 843-766-9105
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Fax | 843-402-9925
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Authorized Official
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Title or Position | OWNER
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Name | DEANNA ELLINGTON CHEEK
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Credential | MD
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Telephone | 843-573-0858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 14170
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License Number State | SC
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