Organization
COLONIAL FAMILY PRACTICE, LLC
Active
Parent organization
COLONIAL FAMILY PRACTICE, LLC
Other names
Colonial Urgent Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Authorized official
MRS. STEPHANIE KNIGHT DISHER (CREDENTIALING SPECIALIST)
(803) 773-5227
Entity
Organization
Contact information
Practice address
327 BROAD ST, SUMTER, SC 29150-4152
(803) 773-5227
(803) 418-0202
Mailing address
325 BROAD ST STE 100, SUMTER, SC 29150-4167
(803) 773-5227
(803) 418-0202
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207QS1201X
Sleep Medicine (Family Medicine) Physician
—
—
207ZC0006X
Clinical Pathology Physician
—
—
2084N0400X
Neurology Physician
—
—
208D00000X
General Practice Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3564
—
SC
Enumeration date
11/04/2019
Last updated
08/08/2023
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