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General NPI Number Information
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NPI Number | 1316251317
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Entity Type | Individual
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Provider Name | JENIECE N GULLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 10040 TWO NOTCH RD
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City | COLUMBIA
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State | SC
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Zip | 29223-4396
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Country | US
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Telephone | 803-788-1153
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749306
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City | ATLANTA
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State | GA
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Zip | 30374-9306
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA054416
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License Number State | PA
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