Individual
JONATHAN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
915 GORDON AVE, RM 206208, THOMASVILLE, GA 31792-6614
(229) 228-2799
Mailing address
3560 W PINETREE BLVD, THOMASVILLE, GA 31792-8822
(850) 445-0918
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/14/2013
Last updated
06/13/2019
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