Individual
JANET P FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
380 HOSPITAL DRIVE, SUITE 410, MACON, GA 31217
(478) 746-5644
(478) 745-4849
Mailing address
PO BOX 2564, MACON, GA 31203
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN071940
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000622146D
—
GA
05
—
000622146E
—
GA
05
—
000622146F
—
GA
05
—
000622146G
—
GA
01
—
391033
WELLCARE
GA
01
—
430022179
PALMETTO GBA
GA
01
—
P00410208
RAILROAD MEDICARE
GA
Enumeration date
03/07/2006
Last updated
06/04/2013
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