Individual
MRS. MICHELLE DAWN MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
131 W JEFFERSON ST, MADISON, GA 30650-1368
(706) 342-2242
Mailing address
1321 PROSPECT RD, MADISON, GA 30650-3151
(706) 474-1625
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT004569
GA
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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