OMAR KEVIN FULLER

LOGANVILLE, GA
NPI1932833050
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: GA  RN264780)
Enumeration Date2022-07-14
Last Update Date2022-07-14
Business Address
OMAR KEVIN FULLER
487 THOMAS DR
LOGANVILLE, GA 30052-7262
Phone number: 973-572-8260
Mailing Address
OMAR KEVIN FULLER
487 THOMAS DR
LOGANVILLE, GA 30052-7262
Phone number: 973-572-8260
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