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Organization

GEORGIA SPORTS MEDICINE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK CULLEN MD (PROPIETOR)
(770) 814-2223
Entity
Organization

Contact information

Practice address
6340 SUGARLOAF PKWY, STE 375, DULUTH, GA 30097-4333
(770) 814-2223
(770) 814-2232
Mailing address
6340 SUGARLOAF PKWY, STE 375, DULUTH, GA 30097-4333
(770) 814-2223
(770) 814-2232

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
043191
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GRP5069
MEDICARE GROUP ID
GA
Enumeration date
12/13/2007
Last updated
10/07/2011
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