Caroline McCullough

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12143 Issued in GA

Practice address

4800 Olde Towne Pkwy Ste 400
Marietta, GA 30068-4424

Phone

(678) 718-2940

NPI assigned

Oct 21, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Caroline Avett Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Laureate Medical Group at Northside, LLCGroup PAC ID 2668458530, 75 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: carolineavett@lmg.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Laureate Medical Group at Northside LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1811037336
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1598482432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W PEACHTREE ST NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093609",
            "telephone_number": "404-892-2131",
            "fax_number": "404-215-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 OLDE TOWNE PKWY STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684424",
            "telephone_number": "678-718-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "CAROLINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-21",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carolineavett@lmg.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "4800 Olde Towne Pkwy Ste 400",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300684424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAROLINE",
            "last_name": "AVETT",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jordan McCoy
• Tyrone McCoy
• Myles Randolph McCrary, MD, PHD
• Nerma S McCrary, AGPCNP-BC
• Jennifer Elizabeth McCuller, CCC-SLP
• Alexus McCullum, RBT
• Steven Leland McCune, MD, PHD
• Britton Mahan McCurdy, LAPC, NCC
• Benjamin Curtis McCutchan, PTA
• Lindsay Lafleur McDaniel, RPH

• Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.