LARRY DEWITT FULLER JR. (NPI# 1700209327) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700209327 |
| Entity Type | Individual |
| Full Name | LARRY DEWITT FULLER JR. |
| Credential | M.A. |
| Practice Address |
307 Old Stone Rd Villa Rica GA 30180-1214 |
| Mailing Address |
6439 Briarwood Ct Riverdale GA 30296-2904 |
| Practice Telephone | 7704598799 |
| Mailing Telephone | 4044330307 |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2014-02-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC007525 | GA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912360421 | Larry Chad Fuller | Student in an Organized Health Care Education/Training Program | 500 University Dr, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033-2360 | 2016-04-01 |
| Street Address |
307 OLD STONE RD |
| City | VILLA RICA |
| State | GA |
| Zip Code | 30180-1214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578754503 | Omobolaji Oluseyi Oyebanjo Popoola | Psychiatry & Neurology | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2007-08-06 |
| 1740769538 | Khadeja Chowdhury | Physician Assistant | 307 Old Stone Rd, Villa Rica, GA 30180 | 2018-08-13 |
| 1760932685 | Mardeea Jartu | Counselor | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2016-10-04 |
| 1881967677 | April C Thomas | Counselor | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2012-02-09 |
| 1386964690 | Potters Hands Institute LLC | Clinic/Center | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2010-06-09 |
| 1922280684 | Mobolaji Shalom Oyebanjo, Inc | Clinic/Center | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2007-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174161624 | Crucible Communication Therapy LLC | Speech-Language Pathologist | 9765 Walnut Grove Trail, Villa Rica, GA 30180 | 2019-12-16 |
| 1366802845 | Medic-pearl, LLC | Ambulance | 1108 Charter Oak Ct, Villa Rica, GA 30180 | 2016-02-26 |
| 1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
| 1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
| 1477890168 | Wesley Douglas Mckenzie | Pharmacist | 2500 Mirror Lake Blvd, Villa Rica, GA 30180 | 2013-01-15 |
| 1497005359 | Malika Remie Rajendra | Optometrist | 600 Hwy 61, Villa Rica, GA 30180 | 2012-09-18 |
| 1972876449 | Catherine Elaine Tyson | Pharmacist | 601 Dallas Road, Villa Rica, GA 30180 | 2012-02-14 |
| 1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
| 1851602874 | Jules Chopin Sybert | Nurse Practitioner | 736 W. Bankhead Hwy, Villa Rica, GA 30180 | 2010-06-24 |
| 1487984019 | Lisa Wood | Occupational Therapy Assistant | 1207 Woods Walk, Villa Rica, GA 30180 | 2010-01-04 |
| Find all providers in zip 30180 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449931 | Constance Haralson | Counselor | 1076 Creekhead Dr, Villa Rica, GA 30180-3420 | 2020-08-24 |
| 1306454624 | Sarah Sistrunk | Counselor | 1010 Summer Cypress Dr, Villa Rica, GA 30180-6979 | 2020-07-22 |
| 1194359836 | Hope Professional Counseling Services | Counselor | 308 Night Fall Ter, Villa Rica, GA 30180-7724 | 2020-03-02 |
| 1003259334 | Journeys Counseling Center, LLC | Counselor | 200 S Carroll Rd, Villa Rica, GA 30180-2606 | 2013-04-17 |
| 1851632376 | Purpose Community Therapeutic Services, LLC | Counselor | 242 Fairfield Rd, Villa Rica, GA 30180-3804 | 2013-03-07 |
| 1508119371 | Ann Hamilton Brown | Counselor | 2545 Lakeside Dr, Villa Rica, GA 30180-4067 | 2012-10-18 |
| 1154618643 | Patrick T Mckay | Counselor | 203 Baywood Ln, Villa Rica, GA 30180-3856 | 2011-07-05 |
| 1902190911 | Ashley Norred Powell | Counselor | 514 W Bankhead Hwy Ste 100, Villa Rica, GA 30180-1737 | 2011-06-07 |
| 1013107960 | Jennifer Ann Forrister | Counselor | 231 S Carroll Rd, Villa Rica, GA 30180-2607 | 2007-07-26 |
| 1902930134 | Rebecca Ann Stanard | Counselor | 7358 South Mitchell Court, Villa Rica, GA 30180 | 2007-03-16 |
| Find all providers in VILLA RICA | ||||
| City | VILLA RICA |
| Zip Code | 30180 |
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| 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.