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General NPI Number Information
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NPI Number | 1548286792
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Entity Type | Individual
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Provider Name | JOE CAMPBELL CULBERTSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 630 MEDICAL DR
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4908
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Country | US
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Telephone | 801-299-3781
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Fax | 801-299-2416
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Provider Business Mailing Address
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Address Line | PO BOX 742353
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City | ATLANTA
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State | GA
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Zip | 30374-2353
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Country | US
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Telephone |
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 160794-1205
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License Number State | UT
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