Organization
BLUE RIDGE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAREY MOLIN GULLY MD (OWNER)
(864) 888-4464
Entity
Organization
Contact information
Practice address
457B HIGHWAY 123, SENECA, SC 29678-0842
(864) 888-4464
Mailing address
457B HIGHWAY 123, SENECA, SC 29678-0842
(864) 888-4464
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
261QR1300X
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHC195
—
SC
Enumeration date
07/30/2010
Last updated
07/30/2010
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