Provider Demographics
NPI:1891988275
Name:GOLEY, MICHAEL GALLETLY (CPNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GALLETLY
Last Name:GOLEY
Suffix:
Gender:M
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:CAMPUS BOX 7593
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-843-4549
Mailing Address - Fax:919-843-0057
Practice Address - Street 1:DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:CAMPUS BOX 7593
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-843-4549
Practice Address - Fax:919-843-0057
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0050-03354363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics