● Active Type 1 · Individual

Timothy Fuller, MD

Surgery·Tifton, GA· NPI 1104153063 · Enumerated 2009 · 16 years on NPI

Fuller is 1 of 5 surgery providers in Tifton and 1 of 268 in Georgia.

NPI age

16 years

Enumerated 2009-11-12

Primary specialty

Surgery

Plus 4 subspecialties

Licensed in

GA, MT

2 states

Status

Active

No deactivations on record

Last NPPES update

2024-01-30

Source: monthly bulk 2026-05

Sole proprietor

May be part of a larger org

How this provider compares

Across 268 active surgery providers in Georgia.

NPI age

16 years

↓ 2 yr below median (18 yr)

State licenses

2 states

Top 82% — 17% of peers are multi-state

Subspecialties

In the 38% of peers with subspecialties

NPI lifetime · 2009 → 2026

2009-11Enumerated in NPPES

2009 2026

Where they practice

Practice location

1641 Madison Ave

Tifton, GA 317943757

📞 2293532284

Mailing address

907 18th St E Ste 400

Tifton, GA 317943684

📞 2293533422

Additional practice locations

1 secondary location on file with NPPES.

Location 2

1333 Surgical Services Way

Kalispell, MT 599014844

📞 4067515392fax 4067515406

Specialties

Allopathic & Osteopathic Physicians › Surgery

Surgery Primary

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

GA license #085351MT license #MED-PHYS-LIC-103773 taxonomy 2086S0129X
Student in an Organized Health Care Education/Training Program

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

taxonomy 390200000X
Surgery

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and...

MT license #MED-PHYS-LIC-103773GA license #085351 taxonomy 208600000X

Practice context

Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.

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How to verify this provider

Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
Check the state license is currently active.State licensing boards publish current status; NPPES does not.
Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.