Healthcare Provider Details

I. General information

NPI: 1548209257
Provider Name (Legal Business Name): STEPHEN PARKER FULTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE # L400
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

777 BANNOCK ST # MC3240
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6760
  • Fax:
Mailing address:
  • Phone: 303-602-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40293
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number2023-03147
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2023-03147
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number40293
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2023-03147
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number01086892A
License Number StateIN
# 7
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberDR.0067380
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: