| Palmetto Health - University Of South Carolina Medical Group | |
|
1079 Dutch Fork Rd Irmo SC 29063-8725 | |
| (803) 749-8900 | |
| Not Available |
| Full Name | Palmetto Health - University Of South Carolina Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 1079 Dutch Fork Rd, Irmo, South Carolina |
| Authorized Official Name and Position | William D. Anderson Iii, (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 8035455005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Palmetto Health - University Of South Carolina Medical Group Po Box 743904 Atlanta GA 30374-3904 Ph: (803) 296-7320 | Palmetto Health - University Of South Carolina Medical Group 1079 Dutch Fork Rd Irmo SC 29063-8725 Ph: (803) 749-8900 |
| NPI Number | 1033607809 |
|---|---|
| Provider Enumeration Date | 04/27/2018 |
| Last Update Date | 04/27/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033607809 | NPI | - | NPPES |
| GP7530 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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