Provider Demographics
NPI:1699826164
Name:GUNTER, PRENTIS RICHARD SR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRENTIS
Middle Name:RICHARD
Last Name:GUNTER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 COUNTRY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7456
Mailing Address - Country:US
Mailing Address - Phone:843-327-4935
Mailing Address - Fax:
Practice Address - Street 1:2165 COUNTRY MANOR DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7456
Practice Address - Country:US
Practice Address - Phone:843-327-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC327877Medicaid
SC327877Medicaid