Provider Demographics
NPI:1043067374
Name:FULGHUM, SHELBY LYNN
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LYNN
Last Name:FULGHUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PARKS MEMORIAL BUILDING
Mailing Address - Street 2:CBX 063
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:229-798-0816
Mailing Address - Fax:
Practice Address - Street 1:235 PARKS MEMORIAL BUILDING
Practice Address - Street 2:CBX 063
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:229-798-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse