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NPI Code Detail

MEDICARE: DR. CAMMIE JO FULP MD

MEDICARE: DR. CAMMIE JO FULP 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 Physician9901530NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2136THOTHERNCBCBSNC

General Provider Information

NPI Number : 1558364828
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAMMIE JO FULP MD
Provider Business Mailing Address
First Line : 1409 YANCEYVILLE ST STE B
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-6961
Country : US
Telephone Number : 743-223-2033
Fax Number : 743-223-4186
Provider Business Practice Location Address
First Line : 1309 LEES CHAPEL RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2601
Country : US
Telephone Number : 336-800-8958
Fax Number : 336-286-5583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 11/14/2024

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