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General NPI Number Information
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NPI Number | 1528124500
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Entity Type | Organization
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Legal Business Name | PAMELA S GULLEY, MD, LLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2718 FORUM BLVD SUITE 4A
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City | COLUMBIA
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State | MO
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Zip | 65203-5451
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Country | US
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Telephone | 573-445-5335
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Fax | 573-445-5337
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Provider Business Mailing Address
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Address Line | 2718 FORUM BLVD SUITE 4A
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City | COLUMBIA
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State | MO
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Zip | 65203-5451
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Country | US
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Telephone | 573-445-5335
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Fax | 573-445-5337
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA S GULLEY
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Credential | M.D.
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Telephone | 573-445-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R4P17
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License Number State | MO
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