Organization
COLUMBIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID WILLIAM GAVIN (OFFICE MANAGER)
(803) 790-4700
Entity
Organization
Contact information
Practice address
4540 TRENHOLM RD, COLUMBIA, SC 29206-4462
(803) 790-4700
(803) 790-6130
Mailing address
4540 TRENHOLM RD, COLUMBIA, SC 29206-4462
(803) 790-4700
(803) 790-6130
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14628
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2807
—
SC
Enumeration date
11/21/2005
Last updated
10/16/2007
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