Individual
JESSE GULISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPA
Contact information
Practice address
205 HOSPITAL DR STE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Mailing address
205 HOSPITAL DR STE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4429
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
820
TN
246ZX2200X
Orthopedic Assistant
820
TN
363A00000X
Physician Assistant
820
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3380640
—
TN
Enumeration date
02/06/2014
Last updated
03/29/2018
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