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NPI Code Detail

MEDICARE: CARYL LYNN GULLEY LMSW

MEDICARE: CARYL LYNN GULLEY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerMSW004069GA

General Provider Information

NPI Number : 1053494138
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARYL LYNN GULLEY LMSW
Provider Business Mailing Address
First Line : 108 BROOKFIELD DR
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-6321
Country : US
Telephone Number : 229-249-9426
Fax Number :
Provider Business Practice Location Address
First Line : 1905 S HUTCHINSON AVE
Second Line :
City : ADEL
State : GA
Zip : 31620-5246
Country : US
Telephone Number : 229-896-4559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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Directions to “ CARYL LYNN GULLEY LMSW” Practice Location

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