NPI 1063852630

Christy Latasha Fuller, LMT

Practitioner Exclusive Provider Organization Decatur, GA

Practice location

Address: 2288 Miriam Ln, Decatur, GA 30032-5551
Phone: (404) 343-8848
Mailing address: 2759 Delk Rd SE, Marietta, GA 30067-8847

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence MT008977 (GA)

Other Exclusive Provider Organization providers in Georgia →

Registry record

NPI: 1063852630
Entity type: Individual
Sex (as registered): Female
NPI issued: 27 Jun 2013
Record last updated: 27 Jun 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.