Individual
MRS. MILDRED FLEMING MCCULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
103 STUARD ST, GAFFNEY, SC 29341-1263
(864) 514-1080
(864) 560-1090
Mailing address
PO BOX 277723, ATLANTA, GA 30384-7723
(864) 560-6000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
19766
SC
363LP0200X
Pediatric Nurse Practitioner
300071
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3570
—
SC
01
—
SCC6123365
MEDICARE PIN
SC
01
—
SCC6125019
MEDICARE PIN
SC
01
—
SCC612H895
MEDICARE PIN
SC
01
—
SCC612J577
MEDICARE PIN
SC
Enumeration date
01/25/2007
Last updated
06/17/2020
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