Healthcare Provider Details

I. General information

NPI: 1568206217
Provider Name (Legal Business Name): TJ FULTON INVESTMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN RD STE 1011
MESA AZ
85201-3222
US

IV. Provider business mailing address

560 W BROWN RD STE 1011
MESA AZ
85201-3222
US

V. Phone/Fax

Practice location:
  • Phone: 480-509-4437
  • Fax: 480-856-9069
Mailing address:
  • Phone: 480-509-4437
  • Fax: 480-856-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: TROY FULTON
Title or Position: CEO
Credential: PMHNP
Phone: 229-220-5628