Individual
NICALER PASHANNA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2645 WILDFLOWER LN, SNELLVILLE, GA 30039-4089
(912) 604-3074
Mailing address
2645 WILDFLOWER LN, SNELLVILLE, GA 30039-4089
(912) 604-3074
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW012374
—
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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