Gregory Wayne McCullough Jr., DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN123489 Issued in GA

Practice address

5505 Peachtree Dunwoody Rd Ste 470
Atlanta, GA 30342-1717

Phone

(404) 254-2709

NPI assigned

Jul 11, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1679310247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 LAKE COURSE DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309043422",
            "telephone_number": "470-814-7790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD STE 470",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421717",
            "telephone_number": "404-254-2709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "GREGORY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN123489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Cloe McCulloch, NP
• Staci Haggerty McCullohs, PA-C
• Amy Elizabeth McCullough, MS, NCC
• Anita McCullough, LMSW
• Carrington Summer McCullough
• Ian Lawrence McCullough, M.D.
• Kaitlin McCullough, LMSW
• Lisa McCullough
• Shawna McCullough, CPNP
• Jasmine V McCully, LCSW

• Dentist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.