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Contact Information

NELSON J FULLER III
503 CONSTITUTION DR
IUKA, MS38852-8201
 Phone: 662-424-9500
 Fax: 662-424-9592
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for NELSON J FULLER III · (Male)

NPI # 1609913276
Status Active
Credentials
Entity Individual
Enumeration date 01/31/2007
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • MS License # PTA4006
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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