Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Family Practice
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
325 BROAD ST STE 200, SUMTER, SC 29150-4167
(803) 773-5227
(803) 418-0202
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
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
07/15/2022
Last updated
07/15/2022
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