Provider Demographics
NPI:1548281397
Name:CULLEY, DONALD A (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:CULLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5400 LAUREL SPRINGS PKWY STE 1403
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6098
Mailing Address - Country:US
Mailing Address - Phone:678-904-5211
Mailing Address - Fax:678-904-5212
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY STE 1403
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6098
Practice Address - Country:US
Practice Address - Phone:678-904-5211
Practice Address - Fax:678-904-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091834A208800000X
GA054434208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H87442Medicare UPIN