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1578997615 NPI number — WILLIAM LESLIE FULLITON PH.D.

NPI Number: 1578997615
Health Care Provider/Practitioner: WILLIAM LESLIE FULLITON PH.D.

Information about “1578997615” NPI (WILLIAM LESLIE FULLITON PH.D.) exists in 1578997615 in HTML format HTML  |  1578997615 in plain Text format TXT  |  1578997615 in PDF (Portable Document Format) PDF  |  1578997615 in an XML format XML  formats.

NPI Number : 1578997615 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578997615",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FULLITON",
    "FirstName": "WILLIAM",
    "MiddleName": "LESLIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1407 UNION AVE STE 1407",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38104-3680",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-276-9606",
    "MailingAddressFaxNumber": "901-276-9607",
    "FirstLinePracticeLocationAddress": "1407 UNION AVE STE 1407",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38104",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-276-9606",
    "PracticeLocationAddressFaxNumber": "901-276-9607",
    "EnumerationDate": "08/26/2013",
    "LastUpdateDate": "01/23/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-17-26623",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "P1531",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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