Healthcare Provider Details

I. General information

NPI: 1275519357
Provider Name (Legal Business Name): DEBORAH KAY FULBRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WAYNE MEMORIAL DR
GOLDSBORO NC
27534-9494
US

IV. Provider business mailing address

PO BOX 5468
MARTINSVILLE VA
24115-5468
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-6012
  • Fax: 919-731-6616
Mailing address:
  • Phone: 276-670-2400
  • Fax: 276-670-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number27184
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: