Healthcare Provider Details

I. General information

NPI: 1649647884
Provider Name (Legal Business Name): GATEWAY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171B MONROE LN
LEXINGTON SC
29072-3904
US

IV. Provider business mailing address

PO BOX 2169
LEXINGTON SC
29071-2169
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-8496
  • Fax: 866-614-3887
Mailing address:
  • Phone: 803-358-6762
  • Fax: 803-358-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA M JEFFCOAT
Title or Position: COO/EXEC VP
Credential:
Phone: 803-957-0500