Healthcare Provider Details

I. General information

NPI: 1902032360
Provider Name (Legal Business Name): FULLER REHABILITATION AND CONSULTING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 RANGELINE RD SUITE 101
THEODORE AL
36582-5223
US

IV. Provider business mailing address

PO BOX 615
RINGGOLD GA
30736-0615
US

V. Phone/Fax

Practice location:
  • Phone: 251-443-5104
  • Fax: 866-748-5843
Mailing address:
  • Phone: 706-965-6131
  • Fax: 706-413-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CARTER D. FULLER
Title or Position: PRESIDENT, CEO
Credential:
Phone: 706-965-0352