Individual
DR. KELLY VLASS CULBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
304 SHORTER AVE NW, SUITE 201, ROME, GA 30165-4290
(706) 509-3330
Mailing address
420 E 2ND AVE, SUITE 103, ROME, GA 30161-3209
(706) 509-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
068717
GA
207Q00000X
Family Medicine Physician
30788
SC
207Q00000X
Family Medicine Physician
LL30788
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003128294B
—
GA
05
—
307885
—
SC
05
—
5919319
—
NC
01
—
P00980725
RAILROAD MEDICARE
SC
Enumeration date
06/30/2008
Last updated
03/10/2023
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