| 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 |