Provider Demographics
NPI:1043282858
Name:FULTON, ROBB L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBB
Middle Name:L
Last Name:FULTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:207 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2727
Mailing Address - Country:US
Mailing Address - Phone:478-787-4266
Mailing Address - Fax:478-787-4199
Practice Address - Street 1:207 GREEN ST
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2727
Practice Address - Country:US
Practice Address - Phone:478-787-4266
Practice Address - Fax:478-787-4199
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110203207Q00000X
GA073325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248272437Medicaid
MO137720044Medicare PIN
MOA03092Medicare UPIN
MO137710016Medicare PIN