Individual
MYRA A GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1135 CARTER ST, COLUMBIA, SC 29204-2811
(803) 786-1183
(803) 754-6051
Mailing address
600 ANTIOCH PL, COLUMBIA, SC 29209-5504
(803) 776-8544
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
74253
SC
Other
Enumeration date
11/22/2011
Last updated
11/22/2011
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