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Organization
PALMETTO PEDIATRICS
Active
Organization
PALMETTO PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L. WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
2450 INDIA HOOK RD, SUITE A, ROCK HILL, SC 29732-3270
(803) 327-5772
(803) 327-9303
Mailing address
PO BOX 60099, CHARLOTTE, NC 28260-0099
(803) 327-5772
(803) 327-9303
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
NULL
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906681
—
NC
05
—
GP0671
—
SC
Enumeration date
07/05/2006
Last updated
04/25/2013
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