Organization
BLUE RIDGE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAREY MOLIN GULLY M.D. (OWNER/PHYSICIAN)
(864) 888-4464
Entity
Organization
Contact information
Practice address
457-B HIGHWAY 123 BYPASS, SENECA, SC 29678
(864) 888-4464
(864) 888-4462
Mailing address
457B HIGHWAY 123, SENECA, SC 29678-0842
(864) 888-4464
(864) 888-4462
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
101794
SC
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
246601
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1060
—
SC
05
—
RHC195
—
SC
Enumeration date
02/07/2006
Last updated
01/25/2011
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