Provider Demographics
NPI:1952465817
Name:PALMETTO PEDIATRIC GASTRO AND NUTRITION
Entity Type:Organization
Organization Name:PALMETTO PEDIATRIC GASTRO AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RATHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:AMARNATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-1006
Mailing Address - Street 1:2113 ADAMS GRV
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6951
Mailing Address - Country:US
Mailing Address - Phone:803-254-1006
Mailing Address - Fax:803-254-2090
Practice Address - Street 1:2113 ADAMS GRV
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6951
Practice Address - Country:US
Practice Address - Phone:803-254-1006
Practice Address - Fax:803-254-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP2993163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterologyGroup - Single Specialty