Provider Demographics
NPI:1144077140
Name:GRANT, WILMEIKA SHEREN GUNTER
Entity type:Individual
Prefix:
First Name:WILMEIKA
Middle Name:SHEREN GUNTER
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 RED POLL WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5153
Mailing Address - Country:US
Mailing Address - Phone:803-626-4642
Mailing Address - Fax:
Practice Address - Street 1:440 RED POLL WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-5153
Practice Address - Country:US
Practice Address - Phone:803-626-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care