| |
4700 Forest Dr Suite 101 Columbia SC 29206 | |
(803) 256-1511 | |
(803) 256-7333 |
Full Name | |
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Speciality | Family Medicine |
Location | 4700 Forest Dr, Columbia, South Carolina |
Authorized Official Name and Position | David Glenn Whaley (PARTNER) |
Authorized Official Contact | 8037735227 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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325 Broad St Ste 100 Sumter SC 29150-4167 Ph: (803) 773-5227 | 4700 Forest Dr Suite 101 Columbia SC 29206 Ph: (803) 256-1511 |
NPI Number | 1770908261 |
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Provider Enumeration Date | 02/20/2014 |
Last Update Date | 10/02/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770908261 | NPI | - | NPPES |
GP 3564 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (South Carolina) | Primary |
363A00000X | Physician Assistant | (South Carolina) | Secondary |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
Lagniappe Medical Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74 Polo Rd, Columbia, SC 29223 Phone: 803-419-7780 Fax: 803-419-7781 | |