Healthcare Provider Details

I. General information

NPI: 1992108963
Provider Name (Legal Business Name): GH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 YACHT HAVEN GRANDE SUITE S-100
ST THOMAS VI
00802-5004
US

IV. Provider business mailing address

6501 RED HOOK PLZ SUITE 201
ST THOMAS VI
00802-1373
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-7342
  • Fax: 340-776-7349
Mailing address:
  • Phone: 340-776-7342
  • Fax: 340-776-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1448
License Number StateVI

VIII. Authorized Official

Name: DR. HILLARY WOODSON GASKINS
Title or Position: OWNER
Credential: M.D.
Phone: 301-300-4022