Healthcare Provider Details

I. General information

NPI: 1831435429
Provider Name (Legal Business Name): COLONIAL FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BROAD ST STE 200
SUMTER SC
29150-4167
US

IV. Provider business mailing address

674 W LIBERTY ST
SUMTER SC
29150-4882
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-418-0202
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-757-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOY KIMBALL
Title or Position: CONTRACT MANAGER
Credential:
Phone: 803-256-1511