Individual
MR. TIMOTHY LOUIS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
428 EAST VANN ROAD, GREENEVILLE, TN 37743-7202
(423) 278-1950
(423) 278-1973
Mailing address
PO BOX 15004, KNOXVILLE, TN 37901
(865) 522-9730
(865) 637-2520
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1343
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4121421
BCBST
TN
01
—
TN01Q1
JD
TN
Enumeration date
11/29/2006
Last updated
02/03/2014
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