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General NPI Number Information
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NPI Number | 1932916699
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Entity Type | Individual
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Provider Name | PERCY DEVON GAILLARD JR.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 1078 BOULEVARD ST
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City | ORANGEBURG
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State | SC
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Zip | 29115-4351
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Country | US
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Telephone | 803-231-8820
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Fax |
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Provider Business Mailing Address
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Address Line | 148 CRAGGY BLUFF RD
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City | ORANGEBURG
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State | SC
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Zip | 29115-8625
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Country | US
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Telephone | 803-231-8820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NCCAP5030012-24NT
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License Number State | SC
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