Healthcare Provider Details

I. General information

NPI: 1194097642
Provider Name (Legal Business Name): FULLER HOME SOLUTIONS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MILAN HIGHWAY SUITE D
MEDINA TN
38355
US

IV. Provider business mailing address

4079 CHRISTMASVILLE RD
MEDINA TN
38355-7634
US

V. Phone/Fax

Practice location:
  • Phone: 731-225-8221
  • Fax:
Mailing address:
  • Phone: 731-225-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number676558
License Number StateTN

VIII. Authorized Official

Name: MR. HARRY DAN FULLER JR.
Title or Position: OWNER
Credential:
Phone: 731-225-8221