Individual
DR. DARRYAL DONERLSON MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2339 LAKE HARBIN RD, MORROW, GA 30260-1905
(770) 961-1222
Mailing address
2339 LAKE HARBIN RD, MORROW, GA 30260-1905
(770) 961-1222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN010775
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100273
AVESIS
GA
01
—
791518
UNITED CONCORDIA
GA
01
—
9181250
DORAL
GA
Enumeration date
09/06/2006
Last updated
07/08/2007
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