Healthcare Provider Details

I. General information

NPI: 1558358788
Provider Name (Legal Business Name): ANGELA MICHELLE CULBRETH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: A. MICHELLE CULBRETH M.D.

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 CANADA RD STE 105
LAKELAND TN
38002-4893
US

IV. Provider business mailing address

2961 CANADA RD STE 105
LAKELAND TN
38002-4893
US

V. Phone/Fax

Practice location:
  • Phone: 901-388-0115
  • Fax: 901-385-7924
Mailing address:
  • Phone: 901-388-0115
  • Fax: 19-385-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD037786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: