Basic Information
| Provider Information | |||||||||
| NPI: | 1699065805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCULLOCH | ||||||||
| FirstName: | GARRY | ||||||||
| MiddleName: | ONEIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1267 HIGHWAY 54 W STE 2200 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302142110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707160051 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1267 HIGHWAY 54 W STE 2200 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302142110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707160051 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 078088 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.