Provider Demographics
NPI:1487699666
Name:FULCHER, JAIME GAIL (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:GAIL
Last Name:FULCHER
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 AKERS MILL RD SE
Mailing Address - Street 2:APT. U13
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2503
Mailing Address - Country:US
Mailing Address - Phone:404-281-8827
Mailing Address - Fax:
Practice Address - Street 1:966 W PACES FERRY RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2648
Practice Address - Country:US
Practice Address - Phone:404-281-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer