Provider Demographics
NPI:1093287955
Name:GULLEY, LEONA RUTH (PA-C)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:RUTH
Last Name:GULLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 MCCALLIE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3209
Mailing Address - Country:US
Mailing Address - Phone:423-310-9582
Mailing Address - Fax:
Practice Address - Street 1:2339 MCCALLIE AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3209
Practice Address - Country:US
Practice Address - Phone:423-310-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3781363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical