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Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE KNIGHT DISHER (CREDENTIALING MANAGER)
(803) 773-5227
Entity
Organization
Contact information
Practice address
220 BROAD ST, SUMTER, SC 29150
(803) 773-5227
(803) 774-5400
Mailing address
325 BROAD ST, SUITE 100, SUMTER, SC 29150-4167
(803) 773-5227
(803) 774-5400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3004568
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3564
—
SC
Enumeration date
04/09/2008
Last updated
03/22/2021
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