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Individual

CHARLES SAMUEL FULK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
400 E ECONOMY ROAD, SUITE 8, MORRISTOWN, TN 37814-3388
(423) 587-4600
(423) 587-1729
Mailing address
400 E ECONOMY RD, SUITE 8, MORRISTOWN, TN 37814-3388
(423) 587-4600
(423) 587-1729

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD014379
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0024632
BLUE CROSS
TN
01
070000633
RAILROAD MEDICARE
GA
05
3715864
TN
01
TN0102
JOHN DEERE HEALTH
TN
Enumeration date
05/17/2006
Last updated
01/02/2015
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