Provider Demographics
NPI:1023609138
Name:MCCULLARS, TAMARA KATE (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KATE
Last Name:MCCULLARS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BELLEVUE RD STE 23
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2888
Mailing Address - Country:US
Mailing Address - Phone:478-272-8580
Mailing Address - Fax:478-275-0012
Practice Address - Street 1:2400 BELLEVUE RD STE 23
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2888
Practice Address - Country:US
Practice Address - Phone:478-272-8580
Practice Address - Fax:478-275-0012
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201636363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner