Provider Demographics
NPI:1790765972
Name:PALMETTO FAMILY CARE
Entity Type:Organization
Organization Name:PALMETTO FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-745-9990
Mailing Address - Street 1:PO BOX 50519
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-0519
Mailing Address - Country:US
Mailing Address - Phone:843-745-9990
Mailing Address - Fax:843-745-0008
Practice Address - Street 1:1455 REMOUNT RD
Practice Address - Street 2:SUITE 1A & 1B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3355
Practice Address - Country:US
Practice Address - Phone:843-745-9990
Practice Address - Fax:843-745-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC12512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2608Medicaid
SCGP2608Medicaid