# PALMETTO ADULT AND CHILDRENS UROLOGY PA

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

## Provider details

- **NPI number:** 1467440644
- **Authorized official:** MRS. AMELIA MUNKBERG (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (843) 797-6600

## Contact information

- **Practice address:** 2890 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
- **Practice address phone:** (843) 797-6600
- **Practice address fax:** (843) 820-1440
- **Mailing address:** 2890 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
- **Mailing address phone:** (843) 797-6600
- **Mailing address fax:** (843) 820-1440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2005
- **Last updated:** 04/20/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7026 | MEDICARE GROUP NUMBER | SC |
| 05 | — | GP4871 | — | SC |