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NPI Code Detail

MEDICARE: ISAAC FULLER

MEDICARE: ISAAC FULLER
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
1363A00000XPhysician Assistant6177SC
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1427806116
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAAC FULLER
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 803-434-6771
Fax Number :
Provider Business Practice Location Address
First Line : 14 RICHLAND MEDICAL PARK DR STE 320
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-6896
Country : US
Telephone Number : 803-434-6771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 02/11/2026

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Directions to “ ISAAC FULLER ” Practice Location

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