Organization
BLUE RIDGE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAREY MOLIN GULLY MD (OWNER)
(864) 888-4464
Entity
Organization
Contact information
Practice address
457 B HWY 123 BYPASS, SENECA, SC 29678
(864) 888-4464
(864) 888-4462
Mailing address
457-B HWY 123 BYPASS, SENECA, SC 29678-0947
(864) 888-4464
(864) 888-4462
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RHC 100
RURAL HEALTH CLINIC
SC
Enumeration date
03/02/2007
Last updated
06/30/2009
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