Jason Keith Fultz, DO
Family Medicine in Madison, AL. Individual provider (NPI-1).
NPI number1164083093
StatusActive
Last updated in NPPESAug 1, 2022
Details
- NPI
- 1164083093
- Entity type
- Individual (NPI-1)
- Name
- Jason Keith Fultz
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 21, 2019
- Certification date
- Aug 1, 2022
- Last updated
- Aug 1, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 2019022592 | MO | Yes |
Practice location
1650 Slaughter Rd Ste AMadison, AL 35758-8610
Phone 256-325-3646 · Fax 256-325-3647
Mailing address
551 E Southampton DrColumbia, MO 65201-4236
Phone 573-884-7733 · Fax 573-882-6228
Other practice locations
551 E Southampton Dr
Columbia, MO 65201-4236
Columbia, MO 65201-4236
Phone 573-884-7733 · Fax 573-882-6228
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