Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | COA010277 | GA |
NPI | 1497116669 |
---|---|
Provider Name | Mrs. Talisha M Fulcher |
First Address | Conyers, GA 30013-1297 |
Second Address | Conyers, GA 30013-1297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2016 |
Last Update Date | 15/03/2016 |