Healthcare Provider Details

I. General information

NPI: 1801854781
Provider Name (Legal Business Name): JYOTSNA FULORIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

21 FERRY LANDING LN NW UNIT 1313
ATLANTA GA
30305-1671
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 504-606-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD.14102R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number102891
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: