MRS. TEAWKA FULLMORE (NPI# 1861884215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1861884215 |
Entity Type | Individual |
Full Name | MRS. TEAWKA FULLMORE |
Credential | NP-C |
Practice Address |
711 Knight Avenue Waycross GA 31501-1943 |
Practice Telephone | 9122839423 |
Practice Fax Number | 9122838204 |
Mailing Telephone | 9122839423 |
Mailing Fax Number | 9122838204 |
Enumeration Date | 2015-02-23 |
Last Update Date | 2016-05-26 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN176193 | GA | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
RN176193 | GA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | MEDICARE GROUP NPI | 1144420530 | 01 |
GA | RAILROAD MEDICARE GROUP ID | CG6045 | 01 |
GA | MEDICARE PTAN | 2025I01375 | 01 |
GA | MEDICARE NPI | 1861884215 | 01 |
RN STATE LICENSE | RN176193 | 01 |
Street Address |
711 KNIGHT AVENUE |
City | WAYCROSS |
State | GA |
Zip Code | 31501-1943 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962906115 | Davenport Health Pa | Family Medicine | 1401 Cherokee Drive, Waycross, GA 31501 | 2018-03-22 |
1962940478 | Blake Darren Aldridge | Physical Therapy Assistant | 401 Preston Street, Waycross, GA 31501 | 2017-02-03 |
1669922142 | Jebediah S. Christy Dds - Waycross Pllc | Dentist | 2271 Memorial Dr, Waycross, GA 31501 | 2016-10-10 |
1558721944 | Jana Kirby | Massage Therapist | 1599 Knight Ave., Kallman Chiropractic Center, Waycross, GA 31501 | 2016-02-29 |
1962877001 | Courtney Baldwin | Specialist/Technologist, Other | 2403 Spurgeon St, Waycross, GA 31501 | 2015-12-01 |
1912389784 | Grayson Stuart Griffis | Dentist | 2103 Tebeau St., Waycross, GA 31501 | 2015-06-29 |
1730561267 | Trishla Amit Desai | Internal Medicine | Memorial Satilla Health, 1900 Tebeau Street, Waycross, GA 31501 | 2015-06-20 |
1316330913 | Hanger Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 512 City Blvd Ste H, Waycross, GA 31501 | 2015-03-06 |
1942699079 | Jose Ramon Martinez | Anesthesiology | 701 City Blvd, Waycross, GA 31501 | 2015-01-13 |
1023356714 | Orthopedics Surgeons of Georgia, LLC | Orthopaedic Surgery | 2015 Alice Street, Waycross, GA 31501 | 2013-01-30 |
Find all providers in zip 31501 |
Taxonomy Code | 363LG0600X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Gerontology |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740788413 | Taylor S Swinea | Nurse Practitioner | 615a Pendleton St, Waycross, GA 31501-4724 | 2018-01-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235746009 | Jummai Folashade Akinrinmade | Nurse Practitioner | 5290 Hidden Valley Ln, Cumming, GA 30028-7024 | 2020-09-25 |
1396350997 | Ellen Allen | Nurse Practitioner | 8040 Highway 54, Sharpsburg, GA 30277-2112 | 2020-09-10 |
1588277867 | Saleta Anica Brogdon | Nurse Practitioner | 10 Muirfield Dr, Covington, GA 30016-6536 | 2020-08-26 |
1043828106 | Shonkeisha Byrd | Nurse Practitioner | 1160 Great River Pkwy, Lawrenceville, GA 30045-7015 | 2020-07-15 |
1558982272 | Irene Kamau | Nurse Practitioner | 3605 Glenbarrett Ln Ne, Marietta, GA 30066-8509 | 2020-05-05 |
1891324133 | Branette Young | Nurse Practitioner | 1120 Lehavre Ct, Hampton, GA 30228-3022 | 2020-04-08 |
1851938559 | Sandra Holloway | Nurse Practitioner | 607 Bethany St, Sparks, GA 31647-7139 | 2019-12-02 |
1013550508 | Monica Smart Mills | Nurse Practitioner | 8315 Champion Trl, Fairburn, GA 30213-4739 | 2019-10-28 |
1063053478 | Emily Elizabeth Adams | Nurse Practitioner | 887 W Marietta St Nw, Atlanta, GA 30318-5252 | 2019-10-07 |
1922661800 | Dorcus Healthcare Services LLC | Nurse Practitioner | 105 Greystone Dr, Guyton, GA 31312-5548 | 2019-04-17 |
Find all providers with the same taxonomy |
Please comment or provide details below to improve the information on MRS. TEAWKA FULLMORE.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.