Provider Demographics
NPI:1881455384
Name:GILLIARD, LATIFAH A (HOME HEALTH PROVIDER)
Entity type:Individual
Prefix:
First Name:LATIFAH
Middle Name:A
Last Name:GILLIARD
Suffix:
Gender:F
Credentials:HOME HEALTH PROVIDER
Other - Prefix:
Other - First Name:LATIFAH
Other - Middle Name:A
Other - Last Name:GILLIARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 MASON ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7507
Mailing Address - Country:US
Mailing Address - Phone:843-819-6175
Mailing Address - Fax:
Practice Address - Street 1:710 MASON ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7507
Practice Address - Country:US
Practice Address - Phone:843-819-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1915163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health