Provider Demographics
NPI:1063073831
Name:MCCULLOUGH, ANDREA BOSS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BOSS
Last Name:MCCULLOUGH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1700 TREE LN STE 300
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6747
Practice Address - Country:US
Practice Address - Phone:678-205-4299
Practice Address - Fax:678-214-6112
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2024-09-25
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Provider Licenses
StateLicense IDTaxonomies
GA101352208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation