Provider Demographics
NPI:1013651959
Name:FULLER, ASHTYN
Entity Type:Individual
Prefix:MS
First Name:ASHTYN
Middle Name:
Last Name:FULLER
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 1:2986 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1236
Mailing Address - Country:US
Mailing Address - Phone:478-321-0517
Mailing Address - Fax:
Practice Address - Street 1:2986 CRESTLINE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1236
Practice Address - Country:US
Practice Address - Phone:478-321-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide