Provider Demographics
NPI:1568206217
Name:TJ FULTON INVESTMENT GROUP LLC
Entity type:Organization
Organization Name:TJ FULTON INVESTMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:229-220-5628
Mailing Address - Street 1:560 W BROWN RD STE 1011
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3222
Mailing Address - Country:US
Mailing Address - Phone:480-509-4437
Mailing Address - Fax:480-856-9069
Practice Address - Street 1:560 W BROWN RD STE 1011
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3222
Practice Address - Country:US
Practice Address - Phone:480-509-4437
Practice Address - Fax:480-856-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty