Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Jane Fullwood, MD

Individual provider Family Medicine Physician · NPI 1306208954

Mary Jane Fullwood, MD is a Family Practice in Selmer, Tennessee. Graduated from University of Tennessee, Hsc, College of Medicine in 2016, 10 years ago. Practices with Trinity Medical Clinic, LLC, a 3-clinician group and works from 2 locations. Licensed in Tennessee.

Years since qualifying
10
Trained at
University of Tennessee, Hsc, College of Medicine
Licensed in
TN
In the registry since
2016
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

832 Mulberry Ave
Selmer, TN 38375-2334
Phone: (731) 434-0200
Fax: (731) 434-0203
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 220 Oakgrove Rd, Selmer, TN 38375 — (731) 646-3699

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 56645 (TN)

Record details

NPI number1306208954
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 23, 2016
Last updated in NPPESDecember 22, 2023
Certification dateDecember 22, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Graduated 2016 (10 years in practice)
Group practice Trinity Medical Clinic, Llc — 3 clinicians
Accepts Medicare assignment Not indicated

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