Individual
BRIAN FULLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
270 E COURT AVE, SELMER, TN 38375
(731) 645-7932
(731) 645-5195
Mailing address
270 E COURT AVE, SELMER, TN 38375-2304
(731) 645-7932
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000055446
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2015
Last updated
06/25/2018
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