Healthcare Provider Details

I. General information

NPI: 1396663209
Provider Name (Legal Business Name): MAURICE GILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018A MAIN ST
COLUMBIA SC
29201-2126
US

IV. Provider business mailing address

9 OAKBROOK VILLAGE CT
COLUMBIA SC
29223-4249
US

V. Phone/Fax

Practice location:
  • Phone: 803-828-3016
  • Fax:
Mailing address:
  • Phone: 803-828-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: