Provider Demographics
NPI:1326066564
Name:GULLY, CAREY MOLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:MOLIN
Last Name:GULLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457- B HWY 123 BYPASS
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
Mailing Address - Country:US
Mailing Address - Phone:864-888-4464
Mailing Address - Fax:864-888-4462
Practice Address - Street 1:457- B HWY 123 BYPASS
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-888-4464
Practice Address - Fax:864-888-4462
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24660208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics