Provider Demographics
NPI:1306575550
Name:CULLER, EMILY CAMPOLONG (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAMPOLONG
Last Name:CULLER
Suffix:
Gender:F
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 1:1017 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4408
Mailing Address - Country:US
Mailing Address - Phone:803-424-1260
Mailing Address - Fax:803-424-1230
Practice Address - Street 1:1017 FAIR ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4408
Practice Address - Country:US
Practice Address - Phone:803-424-1260
Practice Address - Fax:803-424-1230
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4462363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4462OtherSC BOARD OF MEDICAL EXAMINERS