Organization
PALMETTO DIGESTIVE DISEASE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SONYA WYATT (CEO)
(843) 571-0643
Entity
Organization
Contact information
Practice address
2073 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5834
(843) 571-0643
(843) 377-0499
Mailing address
2073 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5834
(843) 571-0643
(843) 377-0499
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0775
—
SC
Enumeration date
05/08/2006
Last updated
05/14/2020
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