Provider Demographics
NPI:1013332600
Name:PALMETTO WELLNESS AND WEIGHTLOSS MD
Entity type:Organization
Organization Name:PALMETTO WELLNESS AND WEIGHTLOSS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:803-646-5003
Mailing Address - Street 1:1397 SILVER BLUFF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8860
Mailing Address - Country:US
Mailing Address - Phone:803-646-5003
Mailing Address - Fax:803-226-0480
Practice Address - Street 1:1397 SILVER BLUFF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8860
Practice Address - Country:US
Practice Address - Phone:803-646-5003
Practice Address - Fax:803-226-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty