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NPI Code Detail

MEDICARE: DR. SEAN DOUGLAS FULLER MD

MEDICARE: DR. SEAN DOUGLAS FULLER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician20144SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063488054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SEAN DOUGLAS FULLER MD
Provider Business Mailing Address
First Line : 7182 WOODROW ST STE 200
Second Line :
City : IRMO
State : SC
Zip : 29063-2832
Country : US
Telephone Number : 803-749-1111
Fax Number : 803-749-0050
Provider Business Practice Location Address
First Line : 7182 WOODROW ST STE 200
Second Line :
City : IRMO
State : SC
Zip : 29063-2958
Country : US
Telephone Number : 803-749-1111
Fax Number : 803-749-0050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 02/26/2024

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Directions to “ DR. SEAN DOUGLAS FULLER MD” Practice Location

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