Healthcare Provider Details

I. General information

NPI: 1285088799
Provider Name (Legal Business Name): JOSHUA MCCULLOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

85 CRYSTAL LAKE DR
SAVANNAH GA
31407-3530
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-7394
  • Fax:
Mailing address:
  • Phone: 920-763-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1756-39
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9037-851
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number101762
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: