Fussell, Fred W

Fussell, Fred W is an sole proprietor health care provider with primary practice located at 210 Washington St Nw Ste. 200, Gainesville GA 30501-3672. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Fussell, Fred W can be contacted via phone (770) 536-3902.

Contact Information

Primary practice address
210 Washington St Nw Ste. 200 Gainesville GA 30501-3672
Phone: (770) 536-3902
Fax: (770) 536-3902
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1302 Georgia

Profile Details

NPI number 1184654170
LBN Legal business name Fussell, Fred W
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 4th, 2006
Last updated Jul 8th, 2007 - about 17 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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Identifiers

StateTypeNumberIssuer
All States NPI 1184654170 NPPES
Georgia MEDICAID 00378111A

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