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

Omar Kevin Fuller

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1932833050

Omar Kevin Fuller is a Nurse Practitioner in Loganville, Georgia. Qualified in 2022, 4 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
4
Licensed in
GA
In the registry since
2022
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Practice location Address checks out

487 Thomas Dr
Loganville, GA 30052-7262
Phone: (973) 572-8260
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence RN264780 (GA)

Record details

NPI number1932833050
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 14, 2022
Last updated in NPPESJuly 14, 2022
Certification dateJuly 13, 2022
Mailing address487 Thomas Dr, Loganville, GA 30052-7262

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Loganville