BLUE RIDGE PEDIATRICS LLC (NPI# 1457324907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457324907 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE PEDIATRICS LLC |
| Practice Address |
457-b Highway 123 Bypass Seneca SC 29678 |
| Mailing Address |
457b Highway 123 Seneca SC 29678-0842 |
| Practice Telephone | 8648884464 |
| Practice Fax Number | 8648884462 |
| Mailing Telephone | 8648884464 |
| Mailing Fax Number | 8648884462 |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2011-01-25 |
| Authorized Official Name | DR. CAREY MOLIN GULLY (OWNER/PHYSICIAN) |
| Authorized Official Telephone | 8648884464 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
101794 | SC | Allopathic & Osteopathic Physicians |
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
246601 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP1060 | 05 | |
| SC | RHC195 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154450757 | Blue Ridge Pediatrics LLC | Clinic/Center | 457 B Hwy 123 Bypass, Seneca, SC 29678 | 2007-03-02 |
| 1104130376 | Blue Ridge Pediatrics LLC | Clinic/Center | 457b Highway 123, Seneca, SC 29678-0842 | 2010-07-30 |
| Street Address |
457-B HIGHWAY 123 BYPASS |
| City | SENECA |
| State | SC |
| Zip Code | 29678 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649803313 | Synergy Spine Center, Pa | Pain Medicine | 457 U.S. Highway 123, Suite D, Seneca, SC 29678 | 2020-02-20 |
| 1437630746 | Greenville Health Corporation | Durable Medical Equipment & Medical Supplies | 10708 Clemson Blvd, Seneca, SC 29678 | 2018-08-24 |
| 1497233415 | Southern Telco, Inc. | Emergency Response System Companies | 15879 Wells Hwy, Seneca, SC 29678 | 2018-08-01 |
| 1598252199 | Chana Ashlan Land | Counselor | 530 By Pass 123 Ste E2, Seneca, SC 29678 | 2018-04-18 |
| 1679972632 | Anesthesia At Synergy Spine | Nurse Anesthetist, Certified Registered | 457 E Bypass 123, Seneca, SC 29678 | 2014-08-15 |
| 1548683303 | Carolina Counseling Professionals, LLC | Community/Behavioral Health | 123 Loblolly Pine Dr, Seneca, SC 29678 | 2014-01-30 |
| 1144658170 | Changing Strides Counseling, LLC | Community/Behavioral Health | 123 Loblolly Pine Dr., Seneca, SC 29678 | 2013-10-30 |
| 1417383811 | Martha Williams | Registered Nurse | 101 Honeybee Ln, Seneca, SC 29678 | 2013-09-18 |
| 1073867404 | The Upstate's Golden Corner of Psychiatry | Psychiatry & Neurology | 450 B Bypass 123, Seneca, SC 29678 | 2012-11-07 |
| 1043569916 | Amanda Lee Simpson | Pharmacist | 105 Foothills Center Drive, West Union, SC 29678 | 2012-09-06 |
| Find all providers in zip 29678 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831162387 | Monica E Silva | Pediatrics | 109 Omni Dr Ste A, Seneca, SC 29672-9448 | 2006-02-07 |
| 1609928472 | Oconee Pediatrics | Pediatrics | 15579 Wells Highway, Seneca, SC 29678-4318 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245486760 | Lisa E Hughes | Pediatrics | 900 Bowman Rd., Mt. Pleasant, SC 29464 | 2008-08-15 |
| 1780860205 | Herbert Lee Smyre | Pediatrics | 106 Sheffield Rd, Greer, SC 29651-1025 | 2008-01-15 |
| 1710181060 | Kudchadkar Clinic | Pediatrics | 880 West Moultrie St, Suite 100, Winnsboro, SC 29180 | 2007-06-12 |
| 1619182482 | Greer Pediatric Clinic LLC | Pediatrics | 554 Memorial Drive Ext Ste C, Greer, SC 29651-1155 | 2007-05-14 |
| 1730248220 | York Pediatrics | Pediatrics | 1538 Health Care Dr, Rock Hill, SC 29732-3857 | 2006-12-08 |
| 1407867351 | Deanne N Geurkink | Pediatrics | 11134 Broad River Rd, Suite D, Irmo, SC 29063-7616 | 2006-08-10 |
| 1114965936 | Christine K Chard | Pediatrics | 23265 Highway 76 E, Clinton, SC 29325-7532 | 2006-06-03 |
| 1164487955 | Mojibola Olayinka Solaja | Pediatrics | 120 Wildewood Park Dr, Suite B, Columbia, SC 29223-4300 | 2006-04-18 |
| 1669432779 | Linda J Crout Wingard | Pediatrics | 2525 Kinard Street, Newberry, SC 29108 | 2006-03-23 |
| 1053383000 | Jonathan C Collins | Pediatrics | 206 Centre South Blvd, Aiken, SC 29803-6319 | 2006-02-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.