NPI | 1225687338 |
---|---|
Doing Business As | COLONIAL FAMILY PRACTICE LIBERTY STREET LOCATION |
Entity Type | Organization |
Authorized Contact | STEPHANIE KNIGHT DISHER Credentialing Specialist 803-773-5227 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207R00000X Internal Medicine |
207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology | |
225100000X Physical Therapist | |
363A00000X Physician Assistant | |
363LF0000X Nurse Practitioner, Family | |
363L00000X Nurse Practitioner | |
363LA2200X Nurse Practitioner, Adult Health | |
Enumeration Date | 2019-09-11 |
Last Update Date | 2020-01-30 |