Provider Demographics
NPI:1558358788
Name:CULBRETH, ANGELA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:CULBRETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:MICHELLE
Other - Last Name:CULBRETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2961 CANADA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4893
Mailing Address - Country:US
Mailing Address - Phone:901-388-0115
Mailing Address - Fax:019-385-7924
Practice Address - Street 1:2961 CANADA RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-4893
Practice Address - Country:US
Practice Address - Phone:901-388-0115
Practice Address - Fax:901-385-7924
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD037786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01958224Medicaid
AK150416001Medicaid
TN2708513OtherCIGNA
TN27418OtherTLC
TN145990OtherUNISON
TNP00044287OtherRAILROAD MEDICARE
TN626001636OtherHEALTH NOW
TN3886337Medicaid
TN4064661OtherBLUE CROSS BLUE SHIELD
TN626001636OtherUSA MANAGED CARE
TN626001636OtherBHSG
TN557903OtherUAHC
TN626001636OtherUNITED HEALTHCARE