Individual
JOHN THOMAS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
12239 CRESSIDA LOOP, DAPHNE, AL 36526-9001
(205) 901-4498
Mailing address
12239 CRESSIDA LOOP, DAPHNE, AL 36526-9001
(205) 901-4498
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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