Provider Demographics
NPI:1194310979
Name:FULLER, JHENELLE (DC)
Entity type:Individual
Prefix:DR
First Name:JHENELLE
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 AVALON PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7661
Mailing Address - Country:US
Mailing Address - Phone:770-329-8613
Mailing Address - Fax:
Practice Address - Street 1:1046 AVALON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7661
Practice Address - Country:US
Practice Address - Phone:770-329-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor