1649405416 NPI number — FULLER REHABILITATION AND CONSULTING SERVICES, INC.

Table of content: (NPI 1649405416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649405416 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:
1649405416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2010
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:
975 COBB PLACE BLVD NW
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-6899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-794-0050
Provider Business Practice Location Address Fax Number:
770-794-0052
Provider Enumeration Date:
05/22/2009

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 , registered in the state of GA ; 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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