MEDICARE: MELISA MCCULLOUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	M6T7R6D3	GA

General Provider Information

NPI Number	:	1225972243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISA MCCULLOUGH

Provider Business Mailing Address
First Line	:	15 FALCONS XING
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30016-8164
Country	:	US
Telephone Number	:	470-219-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 FALCONS XING
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30016-8164
Country	:	US
Telephone Number	:	470-219-9843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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Directions to “ MELISA MCCULLOUGH ” Practice Location

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