Healthcare Provider Details

I. General information

NPI: 1508655895
Provider Name (Legal Business Name): NOAH CULPEPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date: 07/30/2025
Reactivation Date: 09/23/2025

III. Provider practice location address

510 COTTON GIN RD
MONTGOMERY AL
36117-3550
US

IV. Provider business mailing address

510 COTTON GIN RD
MONTGOMERY AL
36117-3550
US

V. Phone/Fax

Practice location:
  • Phone: 334-792-5020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: