Individual
GARY MORGAN GOUDELOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL RIDGE DR, GREENVILLE, SC 29605-4267
(864) 220-7270
(864) 241-9211
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
10729
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107299
—
SC
Enumeration date
10/31/2005
Last updated
07/21/2022
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