Provider Demographics
NPI:1093160020
Name:FULTON, FELICIA RAQUEL
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:RAQUEL
Last Name:FULTON
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 1:741 ERIKA LN
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8305
Mailing Address - Country:US
Mailing Address - Phone:910-551-9435
Mailing Address - Fax:
Practice Address - Street 1:741 ERIKA LN
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8305
Practice Address - Country:US
Practice Address - Phone:910-551-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist