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Individual

DR. PRENTICE MICHAEL MCCULLOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 812-5730
(770) 838-8563
Mailing address
119 AMBULANCE DR, SUITE 202, CARROLLTON, GA 30117-3857
(770) 812-5730
(770) 838-8563

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
58806
GA
207L00000X
Anesthesiology Physician
ME90751
FL

Other

Enumeration date
11/21/2005
Last updated
06/16/2010
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