Healthcare Provider Details

I. General information

NPI: 1730748567
Provider Name (Legal Business Name): PHILLIP ALEXANDER CULP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E HOSPITAL RD
FORT GORDON GA
30905
US

IV. Provider business mailing address

300 W HOSPITAL RD
FORT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-9399
  • Fax:
Mailing address:
  • Phone: 706-787-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75589
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: