Healthcare Provider Details

I. General information

NPI: 1912330945
Provider Name (Legal Business Name): NATHANIEL ASBURY FULLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 N CENTER ST
HICKORY NC
28601-1160
US

IV. Provider business mailing address

6521 BUENA VISTA CT
HICKORY NC
28601-9416
US

V. Phone/Fax

Practice location:
  • Phone: 706-910-6708
  • Fax:
Mailing address:
  • Phone: 706-651-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: