Individual
BRITTANY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2576 LAWRENCEVILLE SUWANEE RD, SUWANEE, GA 30024-7290
(770) 962-4043
Mailing address
1190 WHITEHAWK TRL, LAWRENCEVILLE, GA 30043-6640
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14074172
CAQH
—
Enumeration date
08/01/2017
Last updated
08/03/2017
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