Individual
ALISHIA MARY MCCOULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, FNP-BC
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901
(706) 722-9011
Mailing address
PO BOX 1705, AUGUSTA, GA 30903-1705
(706) 774-7263
(706) 774-7230
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN266834
GA
Other
Enumeration date
06/08/2018
Last updated
07/11/2018
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