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Organization
COLONIAL FAMILY PRACTICE - MANNING
Active
Organization
COLONIAL FAMILY PRACTICE - MANNING
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Family Practice Manning
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
1036 PROFESSIONAL CT, MANNING, SC 29102-2827
(803) 773-5227
(803) 433-5221
Mailing address
325 BROAD ST, SUITE 100, SUMTER, SC 29150-4167
(803) 773-5227
(803) 753-9121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13915
SC
207Q00000X
Family Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/01/2013
Last updated
03/22/2021
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