Organization
PROVIDENCE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRAMPTON W HENDERSON JR. M.D. (MANAGING PARTNER)
(803) 254-5171
Entity
Organization
Contact information
Practice address
2750 LAUREL ST, SUITE 103, COLUMBIA, SC 29204-2023
(803) 254-5171
(803) 779-7403
Mailing address
2750 LAUREL ST, SUITE 103, COLUMBIA, SC 29204-2038
(803) 254-5171
(803) 779-7403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
13507
SC
207Q00000X
Family Medicine Physician
21987
SC
207Q00000X
Family Medicine Physician
Primary
8387
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM5571
RAILROAD MEDICARE
SC
05
—
GP2164
—
SC
Enumeration date
07/08/2005
Last updated
06/23/2010
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