1902032360 NPI number — FULLER REHABILITATION AND CONSULTING SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902032360 NPI number — FULLER REHABILITATION AND CONSULTING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULLER REHABILITATION AND CONSULTING SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902032360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RINGGOLD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30736-0615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-965-6131
Provider Business Mailing Address Fax Number:
706-413-1352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6215 RANGELINE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
THEODORE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36582-5223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-443-5104
Provider Business Practice Location Address Fax Number:
866-748-5843
Provider Enumeration Date:
05/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
CARTER
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
706-965-0352

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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