Provider Demographics
NPI:1396207437
Name:PREMIER PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEZMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-381-2869
Mailing Address - Street 1:2818 PARK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1645
Mailing Address - Country:US
Mailing Address - Phone:803-381-2869
Mailing Address - Fax:
Practice Address - Street 1:110 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6301
Practice Address - Country:US
Practice Address - Phone:803-381-2869
Practice Address - Fax:864-484-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty