Individual
MALLORY FULMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2959 SHARPSBURG MCCULLUM RD, BUILDING C, SUITE C, NEWNAN, GA 30265-2297
(770) 683-0250
(770) 683-4250
Mailing address
119 STRONG RD, NEWNAN, GA 30263-7216
(678) 986-4245
(770) 683-4250
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP008377
GA
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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