Healthcare Provider Details

I. General information

NPI: 1699682740
Provider Name (Legal Business Name): MRS. JANE MICHELLE CULP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WINTER ST
WINTERVILLE GA
30683-1408
US

IV. Provider business mailing address

305 THYATIRA BROCKTON RD
JEFFERSON GA
30549-3066
US

V. Phone/Fax

Practice location:
  • Phone: 706-742-8292
  • Fax:
Mailing address:
  • Phone: 706-248-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00001635
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: