Individual
MS. JENNIFER L FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1103 RUSSELL PKWY, WARNER ROBINS, GA 31088-5537
(478) 922-4091
Mailing address
49 WATER FRONT DR, FORT VALLEY, GA 31030-6007
(478) 396-4774
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
004979
GA
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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