Healthcare Provider Details

I. General information

NPI: 1184703118
Provider Name (Legal Business Name): BEVERLY CLAIRE FULCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 FLOWOOD DR STE 303
FLOWOOD MS
39232-9306
US

IV. Provider business mailing address

2550 FLOWOOD DR STE 303
FLOWOOD MS
39232-9306
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-7700
  • Fax: 601-944-5551
Mailing address:
  • Phone: 601-709-7700
  • Fax: 601-944-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number16516
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: