Healthcare Provider Details

I. General information

NPI: 1518470913
Provider Name (Legal Business Name): GUILLOT ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 PROFESSIONAL DR. SUITE C
MYRTLE SC
29577
US

IV. Provider business mailing address

4130 N.W. 37TH PL. STE C
GAINESVILLE FL
32606
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-1384
  • Fax: 843-213-0200
Mailing address:
  • Phone: 352-377-4111
  • Fax: 352-367-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: THERESA ZERR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 352-377-4111