Most Relevant Information
Provider Data
| NPI Number: | 1003579509 |
| Provider Name: | GEORGE WOODSON GULLY LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 338464 |
Most Important Dates
| Enumeration Date: | 10/21/2021 |
| Last Updated: | 10/21/2021 |
Provider Practice Location
1935 LAKELAND DR STE 900
JACKSON
MS
392165028
Practice Location Phone/Fax
| Phone: | 6017182468 |
| Fax: |
Provider Mailing Location
1935 LAKELAND DR STE 900
JACKSON
MS
392165028
Provider Mailing Phone/Fax
| Phone: | 6017182468 |
| Fax: |