MEDICARE: JAMES WESLEY CULLISON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	045057	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194787408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WESLEY CULLISON MD

Provider Business Mailing Address
First Line	:	150 CLINIC AVE
Second Line	:	SUITE 202
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4401
Country	:	US
Telephone Number	:	770-834-6988
Fax Number	:	770-834-1090

Provider Business Practice Location Address
First Line	:	150 CLINIC AVE
Second Line	:	SUITE 202
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4401
Country	:	US
Telephone Number	:	770-834-6988
Fax Number	:	770-834-1090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	05/17/2024

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