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Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Other names
Colonial Family Practice Liberty Street Location
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE KNIGHT DISHER (CREDENTIALING SPECIALIST)
(803) 773-5227
Entity
Organization
Contact information
Practice address
674 W LIBERTY ST, SUMTER, SC 29150-4882
(803) 773-5227
Mailing address
325 BROAD ST STE 100, SUMTER, SC 29150-4167
(803) 773-5227
(803) 746-7445
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/11/2019
Last updated
01/30/2020
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