Individual
TONYA LEWIS MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
820 E 67TH ST, SAVANNAH, GA 31405-4611
(912) 355-9818
(912) 356-9878
Mailing address
820 E 67TH ST, SAVANNAH, GA 31405-4611
(912) 355-9818
(912) 356-9878
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
034016
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00553825B
—
GA
01
—
582095621
TAX ID
GA
Enumeration date
08/25/2006
Last updated
07/08/2007
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