Organization
24 ON PHYSICIANS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN A FULLER (SECRETARY)
(770) 740-0895
Entity
Organization
Contact information
Practice address
217 S 3RD ST, DANVILLE, KY 40422-1823
(859) 239-5008
(859) 239-6793
Mailing address
PO BOX 19108, BELFAST, ME 04915-4086
(770) 274-0468
(404) 806-4334
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/09/2006
Last updated
08/28/2025
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