Organization
PALMETTO MEDICAL GROUP, PLLC
Active
Parent organization
PALMETTO MEDICAL GROUP, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PALMETTO MEDICAL GROUP, PLLC
Authorized official
AMIT G SHAH (MD)
(803) 548-7007
Entity
Organization
Contact information
Practice address
1505 FUNNY CIDE DR, WAXHAW, NC 28173-7258
(803) 548-7007
Mailing address
1040 EDGEWATER CORPORATE PKWY STE 101, INDIAN LAND, SC 29707-4514
(803) 548-7007
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
N/A
—
Enumeration date
07/31/2017
Last updated
07/31/2017
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