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Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Santee Cooper Urgent Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Authorized official
MRS. STEPHANIE KNIGHT DISHER (CREDENTIALING SPECIALIST)
(803) 773-5227
Entity
Organization
Contact information
Practice address
1013 PROFESSIONAL CT, SUITE A, MANNING, SC 29102-2827
(803) 433-7425
(803) 418-0202
Mailing address
325 BROAD ST STE 100, SUMTER, SC 29150-4167
(803) 773-5227
(803) 746-7445
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
208D00000X
General Practice Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
01/30/2017
Last updated
03/22/2021
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