Samantha Dare Gulledge, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-12847 Issued in NC

Practice address

1099 Medical Center Dr
Suites 100 and 201
Wilmington, NC 28401

Phone

(910) 251-9994

Fax

(910) 763-4666

NPI assigned

Dec 12, 2022

Last updated

May 4, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Dermatology PAGroup PAC ID 7012971609, 52 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.08 of 100Reported as group

Quality

81.28

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sgulledge@aadermaffiliates.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Dermatology, P.a.

  • Specialist
  • Raleigh, NC
  • NPI 1568415586
  Medicare reassignment Care Compare group
• Charlotte Dermatology PA

  • Dermatology Physician
  • Charlotte, NC
  • NPI 1265477251
  Medicare reassignment NPD
• Anne Arundel Dermatology Affiliates PC

  • Dermatology Physician
  • Hunt Valley, MD
  • NPI 1083200794
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1740991504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23329",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 MEDICAL CENTER DR",
            "address_2": "SUITES 100 AND 201",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28401",
            "telephone_number": "910-251-9994",
            "fax_number": "910-763-4666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Whiteville",
            "state": "NC",
            "postal_code": "284723706",
            "country_code": "US",
            "telephone_number": "910-251-9944",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "308 S Bennett St",
            "address_purpose": "LOCATION",
            "city": "Burgaw",
            "state": "NC",
            "postal_code": "284255048",
            "country_code": "US",
            "telephone_number": "910-251-9944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GULLEDGE",
        "first_name": "SAMANTHA",
        "middle_name": "DARE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-12",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marian Deaton Guill, FNP-C
• Taylor Renee Guill
• Apryl Guillory, DNP, MSN, FNP-C
• Marcia Sousa Guimaraes, LPC, CAGS
• Joaquin Guinazu
• Chris Gulley
• Brandon Thomas Gullo, DC
• Caitlin Mary Gullo
• Laurie James Gundlach, DPT
• Laura Nolan Gunn, CCC-SLP

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.