Healthcare Provider Details

I. General information

NPI: 1851068266
Provider Name (Legal Business Name): SARAH FULFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VILLA NOVA ST
CUTHBERT GA
39840-6221
US

IV. Provider business mailing address

PO BOX 177
CUTHBERT GA
39840-0177
US

V. Phone/Fax

Practice location:
  • Phone: 229-366-0906
  • Fax:
Mailing address:
  • Phone: 229-366-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: