Individual
MS. GAYLA DENISE BOUKNIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8213 SPRING FLOWER RD, COLUMBIA, SC 29223-5640
(803) 419-6781
Mailing address
8213 SPRING FLOWER RD, COLUMBIA, SC 29223-5640
(803) 419-6781
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
V04797
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
V04797
—
SC
Enumeration date
02/09/2007
Last updated
07/09/2007
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