| Doctor Name: | MS. GAYLA DENISE BOUKNIGHT |
| NPI Number: | 1568503019 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | V04797 |
| Business Practice Address: | 8213 Spring Flower Rd Columbia, SC - 292235640 |
| Business Phone Number: | 8034196781 |
| Business Fax Number: | |
| Mailing Address: | 8213 Spring Flower Rd, COLUMBIA |
| State: | SC |
| Postal Code: | 292235640 |
| Phone Number: | 8034196781 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | V04797 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |