Healthcare Provider Details

I. General information

NPI: 1790882926
Provider Name (Legal Business Name): FULLER REHABILITATION AND CONSULTING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6064 WILMINGTON PIKE SUGARCREEK PLAZA SHOPPING CENTER
DAYTON OH
45459-7006
US

IV. Provider business mailing address

529 ROLLINS INDUSTRIAL BLVD P.O. BOX 615
RINGGOLD GA
30736-2872
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-4300
  • Fax: 937-848-4310
Mailing address:
  • Phone: 706-965-6131
  • Fax: 706-965-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. WANDA PATRICIA MULLIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 706-965-0323