Provider Demographics
NPI:1215538673
Name:FULTON, ANTHONY J
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:FULTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BOONES MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:WV
Mailing Address - Zip Code:24938-7071
Mailing Address - Country:US
Mailing Address - Phone:304-651-1039
Mailing Address - Fax:
Practice Address - Street 1:1125 JAMES RIVER AND KANAWHA TPKE
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1867
Practice Address - Country:US
Practice Address - Phone:304-651-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant