Provider Demographics
NPI:1063263085
Name:FULFORD, CHRISTI L
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:L
Last Name:FULFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BANKHEAD HWY STE B
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-1919
Mailing Address - Country:US
Mailing Address - Phone:678-664-1833
Mailing Address - Fax:866-993-2651
Practice Address - Street 1:817 BANKHEAD HWY STE B
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-1919
Practice Address - Country:US
Practice Address - Phone:678-664-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24068548246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty