Individual
KEVIN JAMES GIST II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1078 GIST DR, MANNING, SC 29102-5775
(803) 825-7553
Mailing address
1078 GIST DR, MANNING, SC 29102-5775
(803) 825-7553
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/19/2018
Last updated
10/19/2018
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