Provider Demographics
NPI:1942753587
Name:GATHERS, SHAWN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GATHERS
Suffix:
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 1:112 LOCHAVEN DR
Mailing Address - Street 2:207
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5978
Mailing Address - Country:US
Mailing Address - Phone:843-256-3361
Mailing Address - Fax:843-712-7290
Practice Address - Street 1:112 LOCHAVEN DR
Practice Address - Street 2:207
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5978
Practice Address - Country:US
Practice Address - Phone:843-256-3361
Practice Address - Fax:843-712-7290
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No305S00000XManaged Care OrganizationsPoint of Service
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant