Provider Demographics
NPI:1487749438
Name:FUSSELL, BIAAN MIDDLETON (MED)
Entity type:Individual
Prefix:MRS
First Name:BIAAN
Middle Name:MIDDLETON
Last Name:FUSSELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4943
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:
Practice Address - Street 1:2611 LIBERTY HILL RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-1871
Practice Address - Country:US
Practice Address - Phone:803-432-5323
Practice Address - Fax:803-713-3978
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health