Active NPI
Evelyn Fuller, RPH
- Pharmacist
- Union City, GA
National Provider Identifier
1689958480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 021868
- Practice address
- 4617 Jonesboro Rd
Union City, GA 30291-2048 - Phone
- (770) 969-7458
- Fax
- (770) 969-9856
- NPI assigned
- Sep 29, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 021868 | GA | Primary |
| Pharmacist | 183500000X | 12094-40 | WI |
Addresses
Primary practice location
4617 Jonesboro Rd
Union City, GA 30291-2048
Mailing address
7360 Hobgood Rd
Fairburn, GA 30213-2684
Phone (404) 200-0531
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021868 | GA | MD | Pharmacist |
| 12094-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1689958480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7360 HOBGOOD RD",
"city": "FAIRBURN",
"state": "GA",
"postal_code": "302132684",
"telephone_number": "404-200-0531",
"fax_number": "770-969-9777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4617 JONESBORO RD",
"city": "UNION CITY",
"state": "GA",
"postal_code": "302912048",
"telephone_number": "770-969-7458",
"fax_number": "770-969-9856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "EVELYN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-29",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "021868",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "12094-40",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Union City, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.