Prentice Michael McCullough, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

58806 Issued in GA

Practice address

705 Dixie St
Carrollton, GA 30117-3818

Phone

(770) 812-5730

Fax

(770) 838-8563

NPI assigned

Nov 21, 2005

Last updated

Jun 16, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

JS Weill Medical College, Cornell University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

TMC-West Georgia Anesthesia Associates Inc.Group PAC ID 2365456308, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011
• Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015
• Tanner Medical Center-East Alabama Hospital, Wedowee, AL, CCN 011306

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• TMC-West Georgia Anesthesia Associates Inc.

  • Anesthesiology Physician
  • Carrollton, GA
  • NPI 1740252022
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tanner Medical Center, Inc

  dba Tanner Health System

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC/Villa Rica Hospital, Inc

  dba Tanner Health System

  • General Acute Care Hospital
  • Villa Rica, GA
  • NPI 1851388748
  Care Compare affiliation
• Tanner Medical Center Alabama Inc

  dba Tanner Medical Center East Alabama

  • Critical Access Hospital
  • Wedowee, AL
  • NPI 1912428301
  Care Compare affiliation

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276646400000",
    "number": "1619950904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DR",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173857",
            "telephone_number": "770-812-5730",
            "fax_number": "770-838-8563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-812-5730",
            "fax_number": "770-838-8563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "PRENTICE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2010-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME90751",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "58806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Lee Maxwell
• Mary E Maxwell, PA
• MC Medical LLC (Walmart Health)
• Alicia McCall, OT
• Debra A McCollister, RDH
• Latiana Corsheka McDaniel
• Jennifer W. McDonald, CNM, NP-C
• Amanda Hasty McEntyre, RD
• Anne Marie McGee, RD, LD, CDCES
• Kenneth R. McGowan, LPC

• Anesthesiology Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Anesthesiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.