| Premier Physician Group, LLC | |
|
110 Atrium Way Columbia SC 29223-6301 | |
| (803) 381-2869 | |
| (864) 484-8587 |
| Full Name | Premier Physician Group, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 110 Atrium Way, Columbia, South Carolina |
| Authorized Official Name and Position | Dezmond Sumter (PHYSICIAN) |
| Authorized Official Contact | 8033812869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Physician Group, LLC 2818 Park St Columbia SC 29201-1645 Ph: (803) 381-2869 | Premier Physician Group, LLC 110 Atrium Way Columbia SC 29223-6301 Ph: (803) 381-2869 |
| NPI Number | 1396207437 |
|---|---|
| Provider Enumeration Date | 04/05/2019 |
| Last Update Date | 04/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396207437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| 202C00000X | Independent Medical Examiner | (NU) | Secondary |
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