Healthcare Provider Details

I. General information

NPI: 1407764848
Provider Name (Legal Business Name): CARTER FULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 MILLENNIUM CIR
RINGGOLD GA
30736-2775
US

IV. Provider business mailing address

1460 W MAIN ST STE B
CENTRE AL
35960-1139
US

V. Phone/Fax

Practice location:
  • Phone: 256-266-1142
  • Fax: 256-266-1179
Mailing address:
  • Phone: 256-266-1142
  • Fax: 256-266-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0122
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: