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Individual
TAMA FULLER
Active
Individual
TAMA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
021981
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158759
BLUE CROSS BLUE SHIELD
—
01
—
40467
GREAT WEST
—
01
—
4303744
AETNA CAPITATED
—
01
—
550624
AETNA
—
01
—
691301
CIGNA HEALTHCARE
—
Enumeration date
04/20/2006
Last updated
07/13/2026
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