Individual
DR. KENNETH DWAYNE FULKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 HATCHER LN, COLUMBIA, TN 38401-4826
(931) 381-2802
(931) 388-0719
Mailing address
1601 HATCHER LN, COLUMBIA, TN 38401-4826
(931) 381-2802
(931) 388-0719
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD019595
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3059467
—
TN
Enumeration date
08/03/2006
Last updated
07/08/2007
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