Provider Demographics
NPI:1083791461
Name:MCCULLAR, LINDA F (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:F
Last Name:MCCULLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-6781
Mailing Address - Country:US
Mailing Address - Phone:601-581-7600
Mailing Address - Fax:
Practice Address - Street 1:1818 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-6781
Practice Address - Country:US
Practice Address - Phone:601-581-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2408010Medicaid
MS2408010Medicaid
TX8EM910Medicare PIN
F85333Medicare UPIN
080002483Medicare ID - Type Unspecified
TX8EM909Medicare PIN