Individual
RICKY JUSTIN MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
446 POPLAR ST STE B, MACON, GA 31201-3336
(478) 746-0097
(478) 742-4051
Mailing address
2675 WINKLER AVE STE 200, FORT MYERS, FL 33901-9328
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
003572
GA
207RC0000X
Cardiovascular Disease Physician
Primary
65151
GA
Other
Enumeration date
07/08/2009
Last updated
04/27/2026
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