Individual
MARY JANE FULLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
832 MULBERRY AVE, SELMER, TN 38375-2334
(731) 434-0200
(731) 434-0203
Mailing address
832 MULBERRY AVE, SELMER, TN 38375-2334
(731) 434-0200
(731) 434-0203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56645
TN
Other
Enumeration date
03/23/2016
Last updated
12/22/2023
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