Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Family Practice Wesmark
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Authorized official
MRS. STEPHANIE K DISHER (CREDENTIALING SPECIALIST)
(803) 773-5227
Entity
Organization
Contact information
Practice address
308 W WESMARK BLVD, 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
3006640
SC
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/11/2010
Last updated
03/22/2021
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