Provider Demographics
NPI:1619405859
Name:MCCULLOUGH, SARAH CLAIRE (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CLAIRE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-1331
Mailing Address - Fax:
Practice Address - Street 1:711 NATIONAL HWY STE 500
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2669
Practice Address - Country:US
Practice Address - Phone:336-475-9164
Practice Address - Fax:336-475-5818
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81731207Q00000X
NC2023-01229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine