Provider Demographics
NPI:1316046758
Name:FULLER REHABILITATION AND CONSULTING SERVICES INC.
Entity type:Organization
Organization Name:FULLER REHABILITATION AND CONSULTING SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-965-0352
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-0615
Mailing Address - Country:US
Mailing Address - Phone:706-965-6131
Mailing Address - Fax:706-413-1352
Practice Address - Street 1:1135 BELL RD
Practice Address - Street 2:SUITE 316
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3777
Practice Address - Country:US
Practice Address - Phone:615-717-0202
Practice Address - Fax:615-717-0303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULLER REHABILITATION AND CONSULTING SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0952950018Medicare NSC