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Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Family Practice Garners Ferry
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Authorized official
MRS. STEPHANIE KNIGHT DISHER (CREDENTIALING MANAGER)
(803) 773-5227
Entity
Organization
Contact information
Practice address
10441 GARNERS FERRY RD, EASTOVER, SC 29044-9351
(803) 773-5227
Mailing address
674 W LIBERTY ST, SUMTER, SC 29150-4882
(803) 773-5227
(803) 757-4010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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