Active NPI
Charles E Fuller, LPC
- Professional Counselor
- Calhoun, GA
National Provider Identifier
1487986972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC007145
- Practice address
- 189 Professional CT SE
Suite 105
Calhoun, GA 30701-7053 - Phone
- (706) 979-4037
- NPI assigned
- Feb 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC007145 | GA | Primary |
Addresses
Primary practice location
189 Professional CT SE
Suite 105
Calhoun, GA 30701-7053
Mailing address
189 Professional CT SE
Suite 105
Calhoun, GA 30701-7053
Phone (706) 979-4037
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC007145 | Other | GA | STATE OF GEORGIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007145 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367366400000",
"number": "1487986972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "189 PROFESSIONAL CT SE",
"address_2": "SUITE 105",
"city": "CALHOUN",
"state": "GA",
"postal_code": "307017053",
"telephone_number": "706-979-4037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "189 PROFESSIONAL CT SE",
"address_2": "SUITE 105",
"city": "CALHOUN",
"state": "GA",
"postal_code": "307017053",
"telephone_number": "706-979-4037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "CHARLES",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-08",
"last_updated": "2013-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC007145",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF GEORGIA",
"identifier": "LPC007145",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Calhoun, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.