Individual
JENIECE N GULLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10040 TWO NOTCH RD, COLUMBIA, SC 29223-4396
(803) 788-1153
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA054416
PA
Other
Enumeration date
08/02/2010
Last updated
11/12/2024
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