Provider Demographics
NPI:1609801000
Name:HEINLY MCCULLEY, TAMMY H (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:H
Last Name:HEINLY MCCULLEY
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 1:7205 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1746
Mailing Address - Country:US
Mailing Address - Phone:901-757-6100
Mailing Address - Fax:901-757-6109
Practice Address - Street 1:7205 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1746
Practice Address - Country:US
Practice Address - Phone:901-757-6100
Practice Address - Fax:901-757-6109
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD026216207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF96957Medicare UPIN
TN3088507Medicare ID - Type Unspecified