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General NPI Number Information
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NPI Number | 1366641243
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Entity Type | Individual
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Provider Name | HEATH KEAY MCCULLOUGH MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1331 N ELM ST STE 200
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City | GREENSBORO
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State | NC
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Zip | 27401-6304
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Country | US
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Telephone | 336-274-6682
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Fax | 336-274-8097
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Provider Business Mailing Address
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Address Line | PO BOX 85378
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City | CHICAGO
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State | IL
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Zip | 60689-5378
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Country | US
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Telephone | 336-274-6682
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Fax | 336-274-8097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2008-01825
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 2008-01825
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License Number State | NC
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