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Organization
PALMETTO HEALTH ALLIANCE
Active
Organization
PALMETTO HEALTH ALLIANCE
Active
Other names
Powdersville Medical Park
Organization subpart
No
Provider details
NPI number
Authorized official
KENDALL J DURHAM (FINANCIAL SERVICE REP-MANAGER)
(864) 855-5104
Entity
Organization
Contact information
Practice address
15 ROE ROAD, GREENVILLE, SC 29611
(864) 295-2308
(864) 295-2635
Mailing address
PO BOX 2089, EASLEY, SC 29641-2089
(864) 855-5104
(864) 859-9362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE1915
—
SC
Enumeration date
05/08/2007
Last updated
08/22/2020
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