Individual
DARRYL MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5842 N DALE ST, JACKSON, MS 39211-3331
(601) 906-0520
Mailing address
5842 N DALE ST, JACKSON, MS 39211-3331
(601) 906-0520
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
800490647
MS
Other
Enumeration date
02/15/2019
Last updated
02/15/2019
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