Individual
JANA ALLEN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1445 OLD MCDONOUGH HWY SE, SUITE E, CONYERS, GA 30094-5977
(770) 922-9222
(770) 922-8794
Mailing address
1445 OLD MCDONOUGH HWY SE, SUITE E, CONYERS, GA 30094-5977
(770) 922-9222
(770) 922-8794
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN147639
GA
Other
Enumeration date
04/04/2012
Last updated
07/15/2014
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