Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 40951 | SC |
NPI | 1205157658 |
---|---|
Provider Name | Dr. Jarom Nathan Gilstrap |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
406515 | (05) | SC |