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NPI Code Detail

MEDICARE: NIAH YVETTE FULFORD PT, DPT

MEDICARE: NIAH YVETTE FULFORD PT, DPT
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
1225100000XPhysical Therapist050120183AIN
2225100000XPhysical Therapist2305204685VA
3225100000XPhysical TherapistPT015191GA

General Provider Information

NPI Number : 1417071564
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIAH YVETTE FULFORD PT, DPT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-238-7217
Fax Number : 423-238-3473
Provider Business Practice Location Address
First Line : 2838 E ATLANTA RD STE 2
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-2780
Country : US
Telephone Number : 678-782-3609
Fax Number : 678-782-3803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 06/14/2021

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