Individual
ADRIANNE L GOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
198 THOMAS JOHNSON DR, SUITE 101, FREDERICK, MD 21702-4398
(301) 694-0870
(301) 694-7034
Mailing address
198 THOMAS JOHNSON DR, SUITE 101, FREDERICK, MD 21702-4398
(301) 694-0870
(301) 694-7034
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
15636
MD
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9643
TN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
50224
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1531915
—
TN
Enumeration date
05/25/2007
Last updated
08/28/2014
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