Provider Demographics
NPI:1356915201
Name:FULLER, NATALIA M (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:M
Last Name:FULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-7133
Mailing Address - Country:US
Mailing Address - Phone:912-373-4745
Mailing Address - Fax:
Practice Address - Street 1:2247 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-7133
Practice Address - Country:US
Practice Address - Phone:912-373-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty