Fuller, Omar Kevin

Fuller, Omar Kevin is an sole proprietor health care provider with primary practice located at 487 Thomas Dr , Loganville GA 30052-7262. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Fuller, Omar Kevin can be contacted via phone (973) 572-8260.

Contact Information

Primary practice address
487 Thomas Dr Loganville GA 30052-7262
Phone: (973) 572-8260
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X RN264780 Georgia

Profile Details

NPI number 1932833050
LBN Legal business name Fuller, Omar Kevin
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 14th, 2022
Last updated Jul 14th, 2022 - about 3 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.

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