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General NPI Number Information
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NPI Number | 1710872130
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Entity Type | Individual
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Provider Name | CRYSTAL FULLER
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2336 WISTERIA DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-6191
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Country | US
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Telephone | 770-733-1469
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 HILLANDALE DR APT 1524
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City | LITHONIA
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State | GA
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Zip | 30058-4925
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Country | US
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Telephone | 850-567-8659
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | GA
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