NPIMap

Organization Active NPI

Colonial Family Practice, LLC

  • Family Medicine Physician
  • Eastover, SC
National Provider Identifier
1336725209
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Practice address
10441 Garners Ferry Rd
Eastover, SC 29044-9351
Phone
(803) 773-5227
NPI assigned
Mar 22, 2021
Organization subpart
Yes
Parent organization
COLONIAL FAMILY PRACTICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Stephanie Knight Disher
Title
Credentialing Manager
Phone
(803) 773-5227

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

10441 Garners Ferry Rd
Eastover, SC 29044-9351

Mailing address

674 W Liberty St
Sumter, SC 29150-4882
Phone (803) 773-5227

Other names 1

  • Colonial Family Practice Garners Ferry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colonial Family Practice8 organizations share this tax ID, including this one
Part of
Colonial Family Practice

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10441 Garners Ferry Rd
Eastover, SC 29044

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1336725209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "674 W LIBERTY ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504882",
            "telephone_number": "803-773-5227",
            "fax_number": "803-757-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10441 GARNERS FERRY RD",
            "city": "EASTOVER",
            "state": "SC",
            "postal_code": "290449351",
            "telephone_number": "803-773-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL FAMILY PRACTICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLONIAL FAMILY PRACTICE, LLC",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "DISHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "KNIGHT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "803-773-5227",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Family Practice Garners Ferry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastover, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.