Individual
MISS COURTNEY LYNNE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8190
Mailing address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8190
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2252
SC
133V00000X
Registered Dietitian
86168015
SC
Other
Enumeration date
10/20/2021
Last updated
02/08/2022
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