Active NPI
Jennifer Dawn McCullough, M.D.
- Psychiatry Physician
- Macon, GA
National Provider Identifier
1013152362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 075758
- Practice address
- 5398 Thomaston Rd
Macon, GA 31220-8110 - Phone
- (478) 476-8868
- NPI assigned
- Dec 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 075758 | GA | Primary |
Addresses
Primary practice location
5398 Thomaston Rd
Macon, GA 31220-8110
Mailing address
5398 Thomaston Rd
Macon, GA 31220-8110
Phone (478) 476-8868
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 075758 | GA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494374400000",
"number": "1013152362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5398 THOMASTON RD",
"city": "MACON",
"state": "GA",
"postal_code": "312208110",
"telephone_number": "478-476-8868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5398 THOMASTON RD",
"city": "MACON",
"state": "GA",
"postal_code": "312208110",
"telephone_number": "478-476-8868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "JENNIFER",
"middle_name": "DAWN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-15",
"last_updated": "2017-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "075758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.