# PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194214775
- **Authorized official:** WILLIAM D. ANDERSON III, (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (803) 545-5005

## Contact information

- **Practice address:** 9 RICHLAND MEDICAL PARK DR STE 505, COLUMBIA, SC 29203-6844
- **Practice address phone:** (803) 434-2505
- **Practice address fax:** (803) 434-2181
- **Mailing address:** PO BOX 743904, ATLANTA, GA 30374-3904
- **Mailing address phone:** (803) 296-7320
- **Mailing address fax:** (803) 296-7330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | NULL | — |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | — | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | NULL | Yes |
| 2080P0214X | Pediatric Pulmonology Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 05/09/2018
- **Last updated:** 05/09/2018