NATHAN FULLER, LPC014076 — NPI 1841867595 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in CLARKESVILLE, GA)

CMS-1500 Box 24J / 33a • NPI

1841867595

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

261QM0850X

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

224 HERSHELS WAY, CLARKESVILLE, GA, 30523-4169

✓ 9-Digit EDI 837 ZIP+4 (30523-4169)

Practice Phone & Referral Fax

(912) 695-5020

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1841867595 (NATHAN FULLER, LPC014076) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1841867595` (NPI-1 Individual Practitioner)
Provider / Legal Name	NATHAN FULLER, LPC014076
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QM0850X` (Clinic/Center, Adult Mental Health)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	224 HERSHELS WAY, CLARKESVILLE, GA, 30523-4169
Practice Telephone / Fax	Tel: (912) 695-5020
Administrative Mailing Address	224 HERSHELS WAY, CLARKESVILLE, GA, 30523-4169
Enumeration & Last Sync	Enumerated: 2021-06-09 \| CMS Record Updated: 2026-06-17

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

224 HERSHELS WAY, CLARKESVILLE, GA, 30523-4169

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Plain-English Taxonomy & CMS Crosswalk (261QM0850X)

What Does Taxonomy Code 261QM0850X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QM0850X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NATHAN FULLER, LPC014076)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QM0850X` — Clinic/Center, Adult Mental Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: GA \| License: `LPC014076` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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NATHAN FULLER, LPC014076 (NPI #1841867595)