Provider Demographics
NPI:1922869247
Name:GIST, LAFELLE S
Entity Type:Individual
Prefix:
First Name:LAFELLE
Middle Name:S
Last Name:GIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-3910
Mailing Address - Country:US
Mailing Address - Phone:843-598-7613
Mailing Address - Fax:
Practice Address - Street 1:404 CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-3910
Practice Address - Country:US
Practice Address - Phone:843-598-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health