Fuller, Mia
Fuller, Mia is an individual health care provider with primary practice located at 11180 State Bridge Rd Suite 305, Alpharetta GA 30022-7482. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Hand, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist is her primary health care specialty. Fuller, Mia can be contacted via phone (678) 992-0303.Contact Information
Primary practice address
11180 State Bridge Rd Suite 305
Alpharetta GA 30022-7482
Phone: (678) 992-0303
Fax: (678) 992-0302
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Hand | 225XH1200X | OT000932 | Georgia |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | OT000932 | Georgia |
Profile Details
| NPI number | 1619045770 |
|---|---|
| LBN Legal business name | Fuller, Mia |
| Credentials | MS,OTR,CHT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 30th, 2006 |
| Last updated | Aug 16th, 2019 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619045770 | NPPES |
| Georgia | MEDICAID | 501099970B |
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