Active NPI
Farrah-Amoy W. Fullerton, MD
- Pediatrics Physician
- Phenix City, AL
National Provider Identifier
1699352674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD.49771
- Practice address
- 3700 S Railroad St Ste a
Phenix City, AL 36867-2994 - Phone
- (334) 664-0463
- NPI assigned
- Mar 26, 2021
- Last updated
- Dec 17, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD.49771 | AL | Primary |
Addresses
Primary practice location
3700 S Railroad St Ste a
Phenix City, AL 36867-2994
Mailing address
3103 Buttrey Dr NW
Huntsville, AL 35810-2905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210706000256 | GA | Order and Referring Only - Pediatric Medicine | 7012319619 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.49771 | AL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734393600000",
"number": "1699352674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3103 BUTTREY DR NW",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358102905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 S RAILROAD ST STE A",
"city": "PHENIX CITY",
"state": "AL",
"postal_code": "368672994",
"telephone_number": "334-664-0463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLERTON",
"first_name": "FARRAH-AMOY",
"middle_name": "W.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-26",
"last_updated": "2024-12-17",
"certification_date": "2024-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "MD.49771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phenix City, AL
- Donna Susanne Fleitas, PHD
- Cyril F Floyd II, DMD
- Erica Fox, LCSW
- Fresenius Kidney Care Phenix City, LLC (Fresenius Kidney Care Phenix City)
- Philecia Renee Fuller, HOME CARE PROVIDER
- Tiffani Marie Fulmer, PHARMD
- Kimberly Ann Funches-Jackson, M.D.
- Justin Lee Fussell, PHARMD
- Jocelyn Galang-Ray, DDS
- Gary Keogh, MD, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.