Provider Demographics
NPI:1831272087
Name:CULLEY, CHRISTOPHER LEONARD (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEONARD
Last Name:CULLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-768-9510
Mailing Address - Fax:336-768-4155
Practice Address - Street 1:4622 COUNTRY CLUB ROAD
Practice Address - Street 2:SUITE 180
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27023-3770
Practice Address - Country:US
Practice Address - Phone:336-768-9510
Practice Address - Fax:336-768-4155
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103539363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102525Medicaid
NCNC6530AMedicare PIN
NC8102525Medicaid
P69514Medicare ID - Type Unspecified
NC2756509CMedicare PIN