Provider Demographics
NPI:1275822249
Name:PALMETTO PSYCHIATRY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:PALMETTO PSYCHIATRY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-764-3555
Mailing Address - Street 1:4500 FORT JACKSON BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1119
Mailing Address - Country:US
Mailing Address - Phone:803-764-3555
Mailing Address - Fax:803-764-4418
Practice Address - Street 1:4500 FORT JACKSON BLVD STE 270
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1119
Practice Address - Country:US
Practice Address - Phone:803-764-3555
Practice Address - Fax:803-764-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty