Individual
JARROD KANE FULGHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(706) 475-4663
Mailing address
1600 NICKVILLE RD NW, DEWY ROSE, GA 30634-3100
(706) 296-5466
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002069
GA
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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