Emmett Frazer Fuller, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

001674 Issued in GA

Practice address

122 Cherry St NE
Marietta, GA 30060-7206

Phone

(770) 427-2911

Fax

(770) 321-2479

NPI assigned

Oct 11, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538257928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "899 BURNS DR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300677111",
            "telephone_number": "770-321-3424",
            "fax_number": "770-321-2479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607206",
            "telephone_number": "770-427-2911",
            "fax_number": "770-321-2479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EMMETT",
        "middle_name": "FRAZER",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "001674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "11538751",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madeline Ann Fudali, M.S., BCBA
• Gabriela Victoria Fuentes Salichs, MD
• Temesgen Fufa, PHARMD
• Fulfillment Chiropractic, LLC
• Averie Caroline Fuller
• Katria Fuller, LMT
• Andrew Fulton
• James A. Funderburk, M.A., LPC, NCC
• N. Roel Fung-a-Wing, P.T.
• Elisheva Ende Funk, LCSW

• Professional Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Professional Counselor 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.