# COLUMBIA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174506497
- **Authorized official:** MR. DAVID WILLIAM GAVIN (OFFICE MANAGER)
- **Authorized official phone:** (803) 790-4700

## Contact information

- **Practice address:** 4540 TRENHOLM RD, COLUMBIA, SC 29206-4462
- **Practice address phone:** (803) 790-4700
- **Practice address fax:** (803) 790-6130
- **Mailing address:** 4540 TRENHOLM RD, COLUMBIA, SC 29206-4462
- **Mailing address phone:** (803) 790-4700
- **Mailing address fax:** (803) 790-6130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 14628 | SC | Yes |

## Other

- **Enumeration date:** 11/21/2005
- **Last updated:** 10/16/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP2807 | — | SC |