Provider Demographics
NPI:1972739258
Name:PALMETTO DYNAMICS
Entity Type:Organization
Organization Name:PALMETTO DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-234-2216
Mailing Address - Street 1:7001 SAINT ANDREWS RD
Mailing Address - Street 2:STE 319
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:803-234-2216
Mailing Address - Fax:866-263-6551
Practice Address - Street 1:4112 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3025
Practice Address - Country:US
Practice Address - Phone:803-234-2216
Practice Address - Fax:866-263-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health