Provider Demographics
NPI:1336916352
Name:GULLATT, BRI'TIANY
Entity Type:Individual
Prefix:
First Name:BRI'TIANY
Middle Name:
Last Name:GULLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIANY
Other - Middle Name:
Other - Last Name:GULLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:314 WILSON ST N
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4048
Mailing Address - Country:US
Mailing Address - Phone:803-693-6449
Mailing Address - Fax:
Practice Address - Street 1:314 WILSON ST N
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4048
Practice Address - Country:US
Practice Address - Phone:803-693-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information