Individual
TANYA GAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1108 CHARLES ST UNIT B, BEAUFORT, SC 29902-4501
(843) 279-2300
Mailing address
263 BRICKYARD POINT RD S, BEAUFORT, SC 29907-1232
(404) 431-4814
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
310
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169942
NCCAOM
—
01
—
310
BOARD OF MEDICAL EXAMINERS - ACUPUNCTURIST
SC
Enumeration date
06/23/2021
Last updated
06/23/2021
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