1174832174 NPI number — DR. LATOYA BERNICE GATHERS ED.D

Table of content: DR. LATOYA BERNICE GATHERS ED.D (NPI 1174832174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174832174 NPI number — DR. LATOYA BERNICE GATHERS ED.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATHERS
Provider First Name:
LATOYA
Provider Middle Name:
BERNICE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174832174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1908A HAWKINS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29440-3078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-485-5596
Provider Business Mailing Address Fax Number:
843-546-0257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1632 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29527-4848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-485-5596
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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