Provider Demographics
NPI:1659565471
Name:GASPERSON, WINFORD GRAVES (CPO)
Entity Type:Individual
Prefix:MR
First Name:WINFORD
Middle Name:GRAVES
Last Name:GASPERSON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 WAPPOO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2223
Mailing Address - Country:US
Mailing Address - Phone:843-225-0809
Mailing Address - Fax:843-278-9185
Practice Address - Street 1:543 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2223
Practice Address - Country:US
Practice Address - Phone:843-225-0809
Practice Address - Fax:843-278-9185
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3028Medicaid