MEDICARE: PALMETTO FAMILY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	111N00000X	Chiropractor	1600	SC

General Provider Information

NPI Number	:	1053396291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO FAMILY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	900 GREENVILLE DR
Second Line	:
City	:	WILLIAMSTON
State	:	SC
Zip	:	29697-1130
Country	:	US
Telephone Number	:	864-847-1818
Fax Number	:	864-847-5706

Provider Business Practice Location Address
First Line	:	900 GREENVILLE DR
Second Line	:
City	:	WILLIAMSTON
State	:	SC
Zip	:	29697-1130
Country	:	US
Telephone Number	:	864-847-1818
Fax Number	:	864-847-5706

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT M. DURHAM
Credential	:	D.C.
Telephone Number	:	864-847-1818

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	12/06/2011

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Directions to “PALMETTO FAMILY MEDICAL GROUP ” Practice Location

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