MEDICARE: J'QUAN EDWARD GULLEY

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
1	106E00000X	Assistant Behavior Analyst		GA

General Provider Information

NPI Number	:	1508729039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J'QUAN EDWARD GULLEY

Provider Business Mailing Address
First Line	:	1512 STATE ST
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-2744
Country	:	US
Telephone Number	:	478-772-7719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 STATE ST
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-2744
Country	:	US
Telephone Number	:	478-772-7719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ J'QUAN EDWARD GULLEY ” Practice Location

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