Healthcare Provider Details

I. General information

NPI: 1740490564
Provider Name (Legal Business Name): JAMES JEFFERY FULLER RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E ANDREW JOHNSON HWY
GREENEVILLE TN
37745-3098
US

IV. Provider business mailing address

990 RONALD DR
TALBOTT TN
37877-8366
US

V. Phone/Fax

Practice location:
  • Phone: 877-422-0078
  • Fax:
Mailing address:
  • Phone: 865-475-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2322
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: