# PALMETTO ENDOSCOPY PROFESSIONALS PA

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

## Provider details

- **NPI number:** 1710578661
- **Authorized official:** DR. TAVA CUNNINGHAM PHARMD (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (803) 254-8449

## Contact information

- **Practice address:** 2631 FOREST DR, COLUMBIA, SC 29204-2363
- **Practice address phone:** (803) 254-8449
- **Practice address fax:** (803) 254-8984
- **Mailing address:** 2631 FOREST DR, COLUMBIA, SC 29204-2363
- **Mailing address phone:** (803) 254-8449
- **Mailing address fax:** (803) 254-8984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 02/02/2021
- **Last updated:** 02/02/2021