Active NPI
Staci Haggerty McCullohs, PA-C
- Surgical Physician Assistant
- Atlanta, GA
National Provider Identifier
1629294947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 975 Johnson Ferry Rd NE
Suite 100
Atlanta, GA 30342 - Phone
- (404) 256-2157
- Fax
- (404) 303-9798
- NPI assigned
- Apr 17, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 005021 | GA | |
| Surgical Physician Assistant | 363AS0400X | Primary |
Addresses
Primary practice location
975 Johnson Ferry Rd NE
Suite 100
Atlanta, GA 30342
Mailing address
975 Johnson Ferry Rd NE
Suite 100
Atlanta, GA 30342
Phone (404) 256-1311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1629294947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "975 JOHNSON FERRY RD NE",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30342",
"telephone_number": "404-256-1311",
"fax_number": "404-303-9798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 JOHNSON FERRY RD NE",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30342",
"telephone_number": "404-256-2157",
"fax_number": "404-303-9798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOHS",
"first_name": "STACI",
"middle_name": "HAGGERTY",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "005021",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.