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NPI Code Detail

MEDICARE: PALMETTO PRIMARY CARE PHYSICIANS, LLC

MEDICARE: PALMETTO PRIMARY CARE PHYSICIANS, LLC
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
1291U00000XClinical Medical Laboratory
2207Q00000XFamily Medicine 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 : 1609410794
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALMETTO PRIMARY CARE PHYSICIANS, LLC
Provider Business Mailing Address
First Line : PO BOX 530062
Second Line :
City : ATLANTA
State : GA
Zip : 30353-0062
Country : US
Telephone Number : 843-572-7727
Fax Number : 843-569-5899
Provider Business Practice Location Address
First Line : 7611 SAINT ANDREWS RD
Second Line :
City : IRMO
State : SC
Zip : 29063-2834
Country : US
Telephone Number : 803-350-9433
Fax Number : 843-732-2123
Authorized Official
Title or Position : CEO
Name : TERRY CUNNINGHAM
Credential :
Telephone Number : 843-572-7727
Provider Enumeration Date : 10/31/2019
Last Update Date : 05/29/2026

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Directions to “PALMETTO PRIMARY CARE PHYSICIANS, LLC ” Practice Location

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