Provider Demographics
NPI:1629088364
Name:FULLAGAR, TIMOTHY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:FULLAGAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:701 MED TECH PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-232-8301
Mailing Address - Fax:423-232-8304
Practice Address - Street 1:701 MED TECH PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2365
Practice Address - Country:US
Practice Address - Phone:423-232-8301
Practice Address - Fax:423-232-8304
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-09-28
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Provider Licenses
StateLicense IDTaxonomies
TN41401207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery