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General NPI Number Information
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NPI Number | 1932291242
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Entity Type | Organization
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Legal Business Name | PALMETTO FAMILY MEDICINE OF CHESTERFIELD COUNTY, LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 316 2ND ST
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City | CHERAW
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State | SC
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Zip | 29520-2404
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Country | US
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Telephone | 843-921-4851
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Fax | 843-921-4854
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Provider Business Mailing Address
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Address Line | 316 2ND ST
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City | CHERAW
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State | SC
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Zip | 29520-2404
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Country | US
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Telephone | 843-921-4851
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Fax | 843-921-4854
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TRAVIS ANDREW NOVINGER
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Credential | MD
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Telephone | 843-921-4851
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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 | 21964
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License Number State | SC
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