Brian Fullwood, MD
Individual provider Active NPI Family Medicine Physician · Selmer, TN
NPI 1487048880 · NPPES record last updated Jun 25, 2018
Key facts
- NPI
- 1487048880
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD0000055446 (TN)
- Practice address
- 270 E Court Ave
Selmer, TN 38375 - Phone
- (731) 645-7932
- Fax
- (731) 645-5195
- NPI assigned
- Mar 24, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180821001633 | TN | Practitioner - Family Practice | 0143533729 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000055446 | TN | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | MD0000055446 | TN | Yes |
Addresses
Primary practice location
270 E Court Ave
Selmer, TN 38375
Mailing address
270 E Court Ave
Selmer, TN 38375-2304
Phone (731) 645-7932
Other providers in Selmer, TN
- Fast Pace Medical Clinic, PLLC
- Julia M Fields
- Mark Finton
- Kelley Nicole Fowler
- Fullwood Dental Clinic, LLC
- Mary Jane Fullwood
- Patrick Lee Fullwood
- Ronnie Lee Fullwood
- Lakshmanan Ganapathy
- Margaret Ashley Gary
All providers in Selmer, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.