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General NPI Number Information
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NPI Number | 1356325237
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Entity Type | Individual
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Provider Name | RANDY CURTIS FULLERTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/03/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2021 CHURCH ST SUITE 504
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City | NASHVILLE
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State | TN
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Zip | 37203-2021
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Country | US
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Telephone | 615-284-7900
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Fax | 615-284-3488
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Provider Business Mailing Address
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Address Line | 9235 COXBORO CT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7435
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Country | US
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Telephone | 615-661-5283
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16963
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License Number State | TN
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