| NPI | 1902229214 |
|---|---|
| Doing Business As | COLONIAL FAMILY PRACTICE COLUMBIA |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE KNIGHT DISHER Credentialing Manager 803-773-5227 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 25518) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 28747) |
| 261QE0800X Clinic/Center Endoscopy (Licence: SC 17676) | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM1200X Clinic/Center Magnetic Resonance Imaging (MRI) (Licence: SC 07-6916 GLENN GOUDY) | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2021-03-22 |