NPIMap

Organization Active NPI

Fuller Rehabilitation and Consulting Services Inc.

  • Durable Medical Equipment & Medical Supplies
  • Peachtree City, GA
National Provider Identifier
1104923325
Registry record updated May 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
FULLER REHABILITATION AND CONSULTING SERVICES INC.
Practice address
412 Crosstown Rd
Peachtree City, GA 30269-2915
Phone
(770) 486-7577
Fax
(770) 486-7556
NPI assigned
Sep 20, 2006
Reactivated
May 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Wanda Patricia Mullis
Title
Vice President
Phone
(706) 965-0323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

412 Crosstown Rd
Peachtree City, GA 30269-2915

Mailing address

529 Rollins Industrial Blvd
P.O. Box 615
Ringgold, GA 30736-2872
Phone (706) 965-6131

Other identifiers 1

IdentifierTypeStateIssuer
000660074AMedicaidGA

Other names 1

  • Independent Living Aids Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fuller Rehabilitation and Consulting Services Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

412 Crosstown Dr
Peachtree City, GA 30269
Phone (770) 486-7577

Ownership & related parties

Subparts reporting this organization as parent 6

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1104923325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 ROLLINS INDUSTRIAL BLVD",
            "address_2": "P.O. BOX 615",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307362872",
            "telephone_number": "706-965-6131",
            "fax_number": "706-965-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 CROSSTOWN RD",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302692915",
            "telephone_number": "770-486-7577",
            "fax_number": "770-486-7556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER REHABILITATION AND CONSULTING SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-05-08",
        "deactivation_date": "2009-02-05",
        "reactivation_date": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "MULLIS",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "706-965-0323",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000660074A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independent Living Aids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.