NPI Code Detail JSON Logo

1073821609 NPI number — MRS. MICHELLE DAWN MCCULLOUGH

NPI Number: 1073821609
Health Care Provider/Practitioner: MRS. MICHELLE DAWN MCCULLOUGH

Information about “1073821609” NPI (MRS. MICHELLE DAWN MCCULLOUGH) exists in 1073821609 in HTML format HTML  |  1073821609 in plain Text format TXT  |  1073821609 in PDF (Portable Document Format) PDF  |  1073821609 in an XML format XML  formats.

NPI Number : 1073821609 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073821609",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCULLOUGH",
    "FirstName": "MICHELLE",
    "MiddleName": "DAWN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JERNIGAN",
    "OtherFirstName": "MICHELLE",
    "OtherMiddleName": "DAWN",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1321 PROSPECT RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MADISON",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30650-3151",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-474-1625",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "131 W JEFFERSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MADISON",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30650-1368",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-342-2242",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/16/2010",
    "LastUpdateDate": "09/16/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "MT004569",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.