Healthcare Provider Details

I. General information

NPI: 1124021787
Provider Name (Legal Business Name): JULIUS TIMOTHY FULENWIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JULIUS T FULENWIDER M.D.

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 JESSE JEWELL PKWY NE STE B
GAINESVILLE GA
30501-3814
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-5733
  • Fax: 770-534-2114
Mailing address:
  • Phone: 770-219-8420
  • Fax: 770-219-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number017181
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number017181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: