Individual
MR. MICHAEL KEL FULLER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
(678) 212-6350
Mailing address
7642 LEGACY RD, FLOWERY BRANCH, GA 30542-7587
(678) 656-3075
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN210405
GA
Other
Enumeration date
02/17/2013
Last updated
02/17/2013
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