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General NPI Number Information
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NPI Number | 1538180005
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Entity Type | Individual
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Provider Name | GAIL B CORLEY MS RD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6439 GARNERS FERRY RD DORN VA MEDICAL CENTER (120)
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City | COLUMBIA
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State | SC
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Zip | 29209-1639
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Country | US
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Telephone | 803-776-4000
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Fax | 803-695-7978
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Provider Business Mailing Address
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Address Line | 601 VALLEYWOOD CT
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City | COLUMBIA
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State | SC
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Zip | 29212-0819
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Country | US
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Telephone | 803-781-2669
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 482659
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License Number State |
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