Individual
VICKIE LORRAINE FULWIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
591 SENECA CT SE, CONYERS, GA 30094-2648
(404) 447-7939
Mailing address
591 SENECA CT SE, CONYERS, GA 30094-2648
(404) 447-7939
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
049845500
GA
Other
Enumeration date
03/28/2011
Last updated
03/28/2011
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