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Individual

MRS. CHRISTY LATASHA FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
2288 MIRIAM LN, DECATUR, GA 30032-5551
(404) 343-8848
Mailing address
2759 DELK RD SE, MARIETTA, GA 30067-8847
(404) 343-8848

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
MT008977
GA

Other

Enumeration date
06/27/2013
Last updated
06/27/2013
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