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General NPI Number Information
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NPI Number | 1992293013
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Entity Type | Organization
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Legal Business Name | PERTILE GROUP LLC
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 26 FOOT POINT RD
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City | COLUMBIA
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State | SC
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Zip | 29209
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Country | US
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Telephone | 337-991-9276
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Fax | 337-943-0846
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Provider Business Mailing Address
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Address Line | 1509 DULLES DR
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City | LAFAYETTE
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State | LA
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Zip | 70506-3718
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Country | US
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Telephone | 337-991-9276
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Fax | 337-943-0846
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL PERTILE
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Credential | MD
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Telephone | 803-920-4880
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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 |
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