Individual
JAMES WESLEY CULLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 CLINIC AVE, SUITE 202, CARROLLTON, GA 30117-4401
(770) 834-6988
(770) 834-1090
Mailing address
150 CLINIC AVE, SUITE 202, CARROLLTON, GA 30117-4401
(770) 834-6988
(770) 834-1090
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
045057
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
875799007B
—
GA
01
—
REF906223411
MEDICAID REFERENCE NUMBER
GA
Enumeration date
04/03/2006
Last updated
05/17/2024
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