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NPI Code Detail

MEDICARE: PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP

MEDICARE: PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA 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
1104100000XSocial Worker
2133VN1004XPediatric Nutrition Registered Dietitian
3363A00000XPhysician Assistant
42080P0214XPediatric Pulmonology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194214775
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 743904
Second Line :
City : ATLANTA
State : GA
Zip : 30374-3904
Country : US
Telephone Number : 803-296-7320
Fax Number : 803-296-7330
Provider Business Practice Location Address
First Line : 9 RICHLAND MEDICAL PARK DR STE 505
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-6844
Country : US
Telephone Number : 803-434-2505
Fax Number : 803-434-2181
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : WILLIAM D. ANDERSON III,
Credential :
Telephone Number : 803-545-5005
Provider Enumeration Date : 05/09/2018
Last Update Date : 05/09/2018

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Directions to “PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP ” Practice Location

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