Healthcare Provider Details

I. General information

NPI: 1487699666
Provider Name (Legal Business Name): JAIME GAIL FULCHER MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 W PACES FERRY RD NW
ATLANTA GA
30327-2648
US

IV. Provider business mailing address

2383 AKERS MILL RD SE APT. U13
ATLANTA GA
30339-2503
US

V. Phone/Fax

Practice location:
  • Phone: 404-281-8827
  • Fax:
Mailing address:
  • Phone: 404-281-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001096
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: