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General NPI Number Information
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NPI Number | 1144267204
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Entity Type | Organization
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Legal Business Name | GOLDSBORO MEDICAL CLINIC PA
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2400 WAYNE MEMORIAL DR STE I
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City | GOLDSBORO
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State | NC
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Zip | 27534
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Country | US
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Telephone | 919-739-9060
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Fax | 919-739-9099
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Provider Business Mailing Address
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Address Line | 2400 WAYNE MEMORIAL DR STE I
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City | GOLDSBORO
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State | NC
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Zip | 27534
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Country | US
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Telephone | 919-739-9060
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Fax | 919-739-9099
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Authorized Official
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Title or Position | PARTNER/OWNER
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Name | DOUGLAS A FULLINGTON
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Credential | MD
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Telephone | 919-739-9060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 29490
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9600773
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20000016
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9600641
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | NC
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