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General NPI Number Information
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NPI Number | 1497025282
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Entity Type | Organization
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Legal Business Name | GREGORY ALLEN GOLLY CRNA, PC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 2703 PINEHURST DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-2697
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Country | US
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Telephone | 214-477-1182
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Fax |
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Provider Business Mailing Address
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Address Line | 2703 PINEHURST DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-2697
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Country | US
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Telephone | 214-477-1182
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY ALLEN GOLLY
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Credential | CRNA
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Telephone | 214-477-1182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 501795
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License Number State | TX
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