Individual
CHARLES LARRY MCCULLOUCH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1560 NORTH OLIVER ST., BROOKSVILLE, MS 39739
(662) 738-4424
(662) 738-4615
Mailing address
1560 NORTH OLIVER ST., BROOKSVILLE, MS 39739
(662) 738-4424
(662) 738-4615
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13953
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125739
—
MS
01
—
P00147884
RAILROAD MEDICARE
—
Enumeration date
12/30/2005
Last updated
06/19/2018
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