Provider Demographics
NPI:1699422311
Name:FULLAH, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FULLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MINERVA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5032
Mailing Address - Country:US
Mailing Address - Phone:614-927-7615
Mailing Address - Fax:
Practice Address - Street 1:1550 OLD HENDERSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3626
Practice Address - Country:US
Practice Address - Phone:614-456-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator