Mary Jane Fullwood, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

56645 Issued in TN

Practice address

832 Mulberry Ave
Selmer, TN 38375-2334

Phone

(731) 434-0200

Fax

(731) 434-0203

NPI assigned

Mar 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Tennessee, HSC, College of Medicine, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Trinity Medical Clinic, LLC 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hardin Medical Center Hospital, Savannah, TN, CCN 440109
• Magnolia Regional Health Center Hospital, Corinth, MS, CCN 250009
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trinity Medical Clinic, LLC

  • Family Nurse Practitioner
  • Selmer, TN
  • NPI 1013156629

  TN

  Medicare reassignment Care Compare group NPD
• Emg Clinics of Tennessee PLLC

  • Physical Medicine & Rehabilitation Physician
  • Jackson, TN
  • NPI 1962597492
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hardin County General Hospital

  • General Acute Care Hospital
  • Savannah, TN
  • NPI 1699754812

  Hospital

  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428

  Hospital

  Care Compare affiliation
• Magnolia Regional Health Center

  • General Acute Care Hospital
  • Corinth, MS
  • NPI 1699756445

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1306208954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 MULBERRY AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752334",
            "telephone_number": "731-434-0200",
            "fax_number": "731-434-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 MULBERRY AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752334",
            "telephone_number": "731-434-0200",
            "fax_number": "731-434-0203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 Oakgrove Rd",
            "address_purpose": "LOCATION",
            "city": "Selmer",
            "state": "TN",
            "postal_code": "38375",
            "country_code": "US",
            "telephone_number": "731-646-3699",
            "fax_number": "731-646-3687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLWOOD",
        "first_name": "MARY",
        "middle_name": "JANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-23",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "56645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia M Fields, APRN, PMHNP-BC
• Mark Finton, PH. D
• Kelley Nicole Fowler, NP
• Fullwood Dental Clinic, LLC
• Brian Fullwood, MD
• Patrick Lee Fullwood, D.D.S.
• Ronnie Lee Fullwood, DDS
• Lakshmanan Ganapathy, MD
• Margaret Ashley Gary, LPC
• Dyana Alexander Gates, PT

• All providers in Selmer, TN
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.