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General NPI Number Information
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NPI Number | 1326294158
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Entity Type | Organization
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Legal Business Name | E THOMAS CULLOM III MD PLLC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 1029 RIVER OAKS DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9554
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Country | US
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Telephone | 601-664-1000
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Fax | 601-664-2777
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Provider Business Mailing Address
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Address Line | 1029 RIVER OAKS DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9554
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Country | US
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Telephone | 601-664-1000
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Fax | 601-664-2777
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Authorized Official
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Title or Position | MANAGER
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Name | EDWARD THOMAS CULLOM III
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Credential | MD
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Telephone | 601-664-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 11803
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License Number State | MS
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