Provider Demographics
NPI:1174655815
Name:FULGHUM DURGS
Entity Type:Organization
Organization Name:FULGHUM DURGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-367-2488
Mailing Address - Street 1:34 NW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0049
Mailing Address - Country:US
Mailing Address - Phone:912-367-2488
Mailing Address - Fax:912-367-7235
Practice Address - Street 1:34 NW PARK AVE
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0049
Practice Address - Country:US
Practice Address - Phone:912-367-2488
Practice Address - Fax:912-367-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1079420001Medicare NSC