MEDICARE: ANDREW FULTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-65350	GA

General Provider Information

NPI Number	:	1295507226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW FULTON

Provider Business Mailing Address
First Line	:	1505 SUMMER WAY
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30350-3047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 JOHNSON FERRY PL STE B10
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2044
Country	:	US
Telephone Number	:	404-442-2068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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