Provider Demographics
NPI:1568438448
Name:GERRALD, HELENE (DO)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:
Last Name:GERRALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4615 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5741
Mailing Address - Country:US
Mailing Address - Phone:843-497-5929
Mailing Address - Fax:843-497-9940
Practice Address - Street 1:5050 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4910
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-497-9940
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL0601Medicaid
SCTL0601Medicaid