Healthcare Provider Details

I. General information

NPI: 1881276228
Provider Name (Legal Business Name): CALEB MICHAEL GULLEDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMORY RADIOLOGY RESIDENCY PROGRAM 1364 CLIFTON RD NE, RM BG03
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

1364 CLIFTON RD NE RM BG03
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-4686
  • Fax:
Mailing address:
  • Phone: 404-712-4686
  • Fax: 404-712-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301516855
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: