MEDICARE: FULLER REHABILITATION AND CONSULTING SERVICES INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies		GA
2	332BC3200X	Customized Equipment (DME)		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851498125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULLER REHABILITATION AND CONSULTING SERVICES INC.

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

Provider Business Practice Location Address
First Line	:	420 DIVIDEND DRIVE
Second Line	:	SUITE B
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1972
Country	:	US
Telephone Number	:	770-486-7577
Fax Number	:	770-486-7556

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/20/2010

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