Provider Demographics
NPI:1215404702
Name:FULLAH, JONATHAN KARIM
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:KARIM
Last Name:FULLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 AVALON PLACE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783
Mailing Address - Country:US
Mailing Address - Phone:240-601-7287
Mailing Address - Fax:
Practice Address - Street 1:1 RESEARCH CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3221
Practice Address - Country:US
Practice Address - Phone:888-557-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician