Individual
MR. MICHAEL G FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P. T.
Contact information
Practice address
2170 S LAMAR BLVD, OXFORD, MS 38655-5224
(662) 234-8559
(662) 234-7923
Mailing address
2304 JACKSON AVE W, OXFORD, MS 38655-5416
(662) 234-8559
(662) 234-7923
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1336
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120446
—
MS
01
—
51511964
BCBS OF AL
AL
05
—
51511964
—
AL
01
—
650021553
MEDICARE RAILROAD
MS
Enumeration date
06/16/2005
Last updated
05/14/2013
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