# PALMETTO PEDIATRICS

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

## Provider details

- **NPI number:** 1508897109
- **Authorized official:** DANIEL L. WIENS (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (704) 355-0648

## Contact information

- **Practice address:** 2450 INDIA HOOK RD, SUITE A, ROCK HILL, SC 29732-3270
- **Practice address phone:** (803) 327-5772
- **Practice address fax:** (803) 327-9303
- **Mailing address:** PO BOX 60099, CHARLOTTE, NC 28260-0099
- **Mailing address phone:** (803) 327-5772
- **Mailing address fax:** (803) 327-9303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 04/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5906681 | — | NC |
| 05 | — | GP0671 | — | SC |