Individual
REGINALD FULWILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
229 WEST MAIN ST, SUITE 12 3RD FL, WEST POINT, MS 39350-0245
(318) 331-3619
(601) 510-9052
Mailing address
PO BOX 245, PHILADELPHIA, MS 39350
(318) 331-3619
(601) 510-9052
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
R857836
MS
Other
Enumeration date
05/24/2016
Last updated
05/24/2016
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