John Richard Fullick, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1307 Issued in GA

Practice address

2100 Comer Ave
Columbus, GA 31904

Phone

(706) 596-5737

Fax

(706) 596-5727

NPI assigned

Sep 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407956360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5328",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "31906",
            "telephone_number": "706-596-5737",
            "fax_number": "706-596-5727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 COMER AVE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "31904",
            "telephone_number": "706-596-5737",
            "fax_number": "706-596-5727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLICK",
        "first_name": "JOHN",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "1307",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA2857",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Brooke Fuller, FNP-C
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• Karin Layne Fuller, PA-C
• Megan Ondrizek Fuller, SLP
• Catherine A Fulton, DC
• Lisa Michelle Funston, FNP
• Furniture Consultants, Inc. (JD Kinder's Furniture Showrooms)
• Glenn Edward Fussell, M.D.
• Katherine Fussell

• Physician Assistant in Columbus, GA
• Providers in Columbus, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.