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5900 Garners Ferry Rd Columbia SC 29209-1301 | |
(803) 695-5450 | |
(803) 695-5469 |
Full Name | |
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Speciality | Family Medicine |
Location | 5900 Garners Ferry Rd, Columbia, South Carolina |
Authorized Official Name and Position | Darrell C Coven (DIRECTOR OF BUSINESS DEV., FINANCE) |
Authorized Official Contact | 8032331025 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 695-5450 | 5900 Garners Ferry Rd Columbia SC 29209-1301 Ph: (803) 695-5450 |
NPI Number | 1194770958 |
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Provider Enumeration Date | 05/23/2006 |
Last Update Date | 10/14/2008 |
Identifier | Type | State | Issuer |
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1194770958 | NPI | - | NPPES |
GP2836 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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 | |