Individual
TIMOTHY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1641 MADISON AVE, TIFTON, GA 31794-3757
(229) 353-2284
Mailing address
907 18TH ST E STE 400, TIFTON, GA 31794-3684
(229) 353-3422
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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