Individual provider · Type 1 NPI

Michael Kel Fuller Sr., RN

Psychiatric/Mental Health Registered Nurse · Lawrenceville, GA

NPI number 1366782005 Active

Practice location

175 Gwinnett Dr
Lawrenceville, GA 30046-8444

Call (678) 209-2394 Map

Fax (678) 212-6350

Mailing address

7642 Legacy Rd
Flowery Branch, GA 30542-7587

Specialties and licenses

Taxonomy	Code	License
Psychiatric/Mental Health Registered Nurse Primary	163WP0808X	RN210405 (GA)

Psychiatric/Mental Health Registered Nurse: Definition to come...

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About NPI 1366782005

Michael Kel Fuller Sr., RN's National Provider Identifier is 1366782005, issued on Feb 17, 2013. The primary taxonomy on file is Psychiatric/Mental Health Registered Nurse (163WP0808X), and the practice location is in Lawrenceville, GA. The record was last updated on Feb 17, 2013.