Healthcare Provider Details

I. General information

NPI: 1447639125
Provider Name (Legal Business Name): EDWARD HENDRIK FULTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 INDEPENDENCE DR
BIRMINGHAM AL
35209
US

IV. Provider business mailing address

3560 INDEPENDENCE DR
BIRMINGHAM AL
35209-5703
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2806
  • Fax: 205-949-2810
Mailing address:
  • Phone: 205-949-2834
  • Fax: 205-949-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD.37372
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: