Organization
PALMETTO MEDICAL GROUP, PLLC
Active
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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