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Organization

COLONIAL FAMILY PRACTICE, LLC

Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Family Practice Garners Ferry
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
10441 GARNERS FERRY RD, EASTOVER, SC 29044-9351
(803) 773-5227
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
363AM0700X
Medical Physician Assistant
363L00000X
Nurse Practitioner
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
03/22/2021
Last updated
03/22/2021
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