Individual
MR. JOHN RICHARD FULLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904
(706) 596-5737
(706) 596-5727
Mailing address
PO BOX 5328, COLUMBUS, GA 31906
(706) 596-5737
(706) 596-5727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1307
GA
363A00000X
Physician Assistant
PA2857
FL
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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