Provider Demographics
NPI:1447241344
Name:GIRAULT, GISELE J (MD)
Entity Type:Individual
Prefix:DR
First Name:GISELE
Middle Name:J
Last Name:GIRAULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GISELE
Other - Middle Name:J
Other - Last Name:GIRAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1750 HIGHWAY 160 WEST
Mailing Address - Street 2:SUITE 101#319
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-1759
Mailing Address - Country:US
Mailing Address - Phone:803-802-7100
Mailing Address - Fax:803-802-8378
Practice Address - Street 1:342 PATRICIA LN STE 102
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6608
Practice Address - Country:US
Practice Address - Phone:803-802-7100
Practice Address - Fax:803-802-8378
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23340174400000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3866Medicaid
SCT73364Medicaid
SCF97660Medicare UPIN
SCGP3866Medicaid