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General NPI Number Information
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NPI Number | 1932132073
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Entity Type | Organization
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Legal Business Name | PALMETTO STATE STAFFING GROUP, LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 113 CHEROKEE RD SUITE 2
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City | FLORENCE
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State | SC
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Zip | 29501-5247
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Country | US
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Telephone | 843-413-0609
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Fax | 843-413-0626
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Provider Business Mailing Address
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Address Line | 113 CHEROKEE RD SUITE 2
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City | FLORENCE
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State | SC
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Zip | 29501-5247
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Country | US
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Telephone | 843-413-0609
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Fax | 843-413-0626
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Authorized Official
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Title or Position | PARTNER
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Name | DR. HOMER FRANKLIN GAMBLE
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Credential | MD
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Telephone | 843-413-0609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | 07141
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License Number State | SC
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