Healthcare Provider Details

I. General information

NPI: 1275227993
Provider Name (Legal Business Name): CALLY CULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BROWNING RD STE 195
COLUMBIA SC
29210-6941
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 410
NASHVILLE TN
37217-2665
US

V. Phone/Fax

Practice location:
  • Phone: 803-999-3752
  • Fax:
Mailing address:
  • Phone: 615-696-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-266078
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: