Organization
PALMETTO UROLOGICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER L MITCHELL (OFFICE MANAGER)
(864) 244-1220
Entity
Organization
Contact information
Practice address
11 PARK CREEK DR, GREENVILLE, SC 29605-4270
(864) 242-1220
Mailing address
11 PARK CREEK DR, GREENVILLE, SC 29605-4270
(864) 242-1220
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA0784-PA
—
SC
Enumeration date
06/19/2006
Last updated
08/22/2020
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