Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 017181 | GA |
N | 208600000X | Surgeon | 017181 | GA |
Y | 2086S0129X | Vascular Surgeon | 017181 | GA |
NPI | 1124021787 |
---|---|
Provider Name | Julius Timothy Fulenwider |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 09/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00199086C | (05) | GA |
D29510 | (02) | GA |