Provider Demographics
NPI:1902864192
Name:FARR, GIST HENRY JR
Entity Type:Individual
Prefix:DR
First Name:GIST
Middle Name:HENRY
Last Name:FARR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S PINE ST APT E
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2712
Mailing Address - Country:US
Mailing Address - Phone:864-582-4792
Mailing Address - Fax:
Practice Address - Street 1:410 S PINE ST APT E
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2712
Practice Address - Country:US
Practice Address - Phone:864-582-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5363207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF09188Medicare UPIN