Individual
TIMOTHY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
085351
GA
208600000X
Surgery Physician
MED-PHYS-LIC-103773
MT
2086S0129X
Vascular Surgery Physician
Primary
085351
GA
2086S0129X
Vascular Surgery Physician
MED-PHYS-LIC-103773
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/12/2009
Last updated
01/30/2024
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