Most Relevant Information
Provider Data
| NPI Number: | 1003395385 |
| Provider Name: | BLAIR GAULT |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 22024 |
Most Important Dates
| Enumeration Date: | 08/08/2018 |
| Last Updated: | 11/21/2018 |
Provider Practice Location
1888 BOILING SPRINGS RD
BOILING SPRINGS
SC
29316
Practice Location Phone/Fax
| Phone: | 8663892727 |
| Fax: |
Provider Mailing Location
1888 BOILING SPRINGS RD
BOILING SPRINGS
SC
293165124
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |