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Organization
NORTHLAKE FAMILY MEDICAL PRACTICE
Active
Organization
NORTHLAKE FAMILY MEDICAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINALD L PARKER MD (OWNER)
(803) 419-5131
Entity
Organization
Contact information
Practice address
3000 NE MEDICAL PARK, STE 101, COLUMBIA, SC 29223-6251
(803) 419-5131
(803) 419-5130
Mailing address
3000 NE MEDICAL PARK, STE 101, COLUMBIA, SC 29223-6251
(803) 419-5131
(803) 419-5130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14862
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4438
—
SC
Enumeration date
08/31/2006
Last updated
10/16/2007
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