Healthcare Provider Details

I. General information

NPI: 1770321333
Provider Name (Legal Business Name): TRANSFORMED TO YOUR FULLER LIFE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 TEAL LAKE DR
SAVANNAH GA
31419-7519
US

IV. Provider business mailing address

28 TEAL LAKE DR
SAVANNAH GA
31419-7519
US

V. Phone/Fax

Practice location:
  • Phone: 404-518-0272
  • Fax:
Mailing address:
  • Phone: 404-518-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DR. ARLEEN ANNETTE FULLER
Title or Position: CEO
Credential: PHD
Phone: 404-518-0272