# PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP

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

## Provider details

- **NPI number:** 1851880090
- **Authorized official:** WILLIAM D. ANDERSON III, (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (803) 545-5005

## Contact information

- **Practice address:** 11 ATRIUM RIDGE CT, COLUMBIA, SC 29223-6438
- **Practice address phone:** (803) 699-9992
- **Practice address fax:** (803) 865-7429
- **Mailing address:** PO BOX 743904, ATLANTA, GA 30374-3904
- **Mailing address phone:** (803) 296-7320
- **Mailing address fax:** (803) 296-7330

## 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 |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/03/2018
- **Last updated:** 05/03/2018