Individual
SAMUEL T. GULLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
868 YORK AVE SW, ATLANTA, GA 30310-2750
(404) 752-1400
(404) 756-8749
Mailing address
868 YORK AVE SW, ATLANTA, GA 30310-2750
(404) 752-1400
(404) 756-8749
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN007174
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
472755115A
—
GA
Enumeration date
03/29/2006
Last updated
10/22/2009
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