Healthcare Provider Details

I. General information

NPI: 1932593548
Provider Name (Legal Business Name): FULLER MCCABE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2055
US

IV. Provider business mailing address

305 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2055
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax:
Mailing address:
  • Phone: 205-345-0192
  • Fax: 205-759-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27163
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: