Individual
MRS. TALISHA M FULCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
1540 HIGHWAY 138 SE, CONYERS, GA 30013-1297
(770) 761-9908
Mailing address
1540 HIGHWAY 138 SE, CONYERS, GA 30013-1297
(770) 761-9908
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
COA010277
GA
Other
Enumeration date
03/15/2016
Last updated
03/15/2016
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