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General NPI Number Information
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NPI Number | 1356130165
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Entity Type | Individual
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Provider Name | KELSEY MARIE FULLEM RBT
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 4319 S LEE ST STE 200
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City | BUFORD
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State | GA
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Zip | 30518-5752
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Country | US
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Telephone | 678-288-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CHERRYSTONE WALK
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City | SUWANEE
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State | GA
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Zip | 30024-2379
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Country | US
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Telephone | 706-531-4152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-339565
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License Number State | GA
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