Provider Demographics
NPI:1104945906
Name:MCCULLOUGH, HEATH BYRON (ATC)
Entity type:Individual
Prefix:MR
First Name:HEATH
Middle Name:BYRON
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 CRAWFORD LN
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:TN
Mailing Address - Zip Code:37306-2152
Mailing Address - Country:US
Mailing Address - Phone:931-967-8960
Mailing Address - Fax:931-968-9869
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2470
Practice Address - Country:US
Practice Address - Phone:931-968-1232
Practice Address - Fax:931-968-9869
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT2992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer