Colonial Family Practice, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COLONIAL FAMILY PRACTICE, LLC

Doing business as

Colonial Family Practice Columbia

Practice address

4700 Forest Dr
Suite 101
Columbia, SC 29206

Phone

(803) 256-1511

Fax

(803) 256-7333

NPI assigned

Feb 20, 2014

Organization subpart

No

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

Authorized official

Name

David Glenn Whaley, MD

Title

Partner

Phone

(803) 773-5227

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Colonial Family Practice Columbia Doing business as
• CFP Forest Acres 101 Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1770908261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 BROAD ST STE 100",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504167",
            "telephone_number": "803-773-5227",
            "fax_number": "803-773-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 FOREST DR",
            "address_2": "SUITE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29206",
            "telephone_number": "803-256-1511",
            "fax_number": "803-256-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-20",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "WHALEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "803-773-5227",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP 3564",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Family Practice Columbia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CFP Forest Acres 101",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CFP Forest Acres 101",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tracey Moats Collins, RPH
• Michelle Carolyn Collymore
• Ricardo Colon II, RN
• Colonial Family Practice & Ambulatory Care Center
• Colonial Family Practice NE
• Bailey Colquitt, LPC
• Shenita Renea Colson, APRN
• Charlotte Colt
• Debra Colter, RT
• Lashon Colter

• Family Medicine Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.