Individual
WILLIAM T CULCLASURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Mailing address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A714
SC
363A00000X
Physician Assistant
Primary
714
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1068PA
—
SC
01
—
576001305006
BCBS PROVIDER NUMBER
SC
Enumeration date
06/12/2006
Last updated
11/01/2022
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