Individual
CHARLES L. GAILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
526 NORTH ST, BAMBERG, SC 29003-1319
(803) 245-2433
(803) 245-7424
Mailing address
PO BOX 524, BAMBERG, SC 29003-0524
(803) 245-2433
(803) 245-7424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22444
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
423828
MEDICARE UNSPECIFIED
SC
01
—
428926
MEDICARE UNSPECIFIED
—
05
—
RHC020
—
SC
05
—
RHC151
—
SC
Enumeration date
10/31/2007
Last updated
06/03/2011
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