Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D1730 | TX |
NPI | 1003823352 |
---|---|
Provider Name | James Albright Mccullough |
First Address | Peachtree City, GA 30269-4212 |
Second Address | Peachtree City, GA 30269-4212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F50993 | (02) | TX |