Individual
TARA GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 REGISTER ST, CHARLESTON, SC 29405-2421
(843) 740-3147
Mailing address
11100 NNPTC CIRCLE, GOOSE CREEK, SC 29445
(740) 317-7449
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
—
—
171000000X
Military Health Care Provider
—
—
1710I1002X
Independent Duty Corpsman
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
03/02/2007
Last updated
02/19/2026
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