Provider Demographics
NPI:1376253278
Name:PALMER, CURTIS T
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:T
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-7761
Mailing Address - Country:US
Mailing Address - Phone:864-441-2293
Mailing Address - Fax:
Practice Address - Street 1:112 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-7761
Practice Address - Country:US
Practice Address - Phone:864-441-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101062187172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver