Provider Demographics
NPI:1841151172
Name:WARD, GERIANEE OCTAVIA
Entity type:Individual
Prefix:
First Name:GERIANEE
Middle Name:OCTAVIA
Last Name:WARD
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 1:102 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3406
Mailing Address - Country:US
Mailing Address - Phone:843-864-4125
Mailing Address - Fax:
Practice Address - Street 1:102 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3406
Practice Address - Country:US
Practice Address - Phone:843-864-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant