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
1	133NN1002X	Nutrition Education Nutritionist
2	207Q00000X	Family Medicine Physician	22293	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1639118524
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	:	843-695-6071
Fax Number	:	843-569-5881

Provider Business Practice Location Address
First Line	:	1254 YEAMANS HALL RD
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-2787
Country	:	US
Telephone Number	:	843-554-8312
Fax Number	:	843-554-5141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS BRANTLEY ARNAU
Credential	:	MD
Telephone Number	:	843-572-7727

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	06/01/2021

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