Individual
MR. JAMES EVANS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2107 N DECATUR RD, #166, DECATUR, GA 30033-5305
(404) 321-6111
Mailing address
2107 NORTH DECATUR RD., #166, DECATUR, GA 30033
(404) 321-6111
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001998
GA
Other
Enumeration date
07/21/2006
Last updated
07/08/2007
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