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NPI Code Detail

MEDICARE: JAMES W FULLER PHD INC

MEDICARE: JAMES W FULLER PHD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904000574VA

General Provider Information

NPI Number : 1518054733
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMES W FULLER PHD INC
Provider Business Mailing Address
First Line : 2410 LARKWOOD ROAD
Second Line :
City : RICHMOND
State : VA
Zip : 23294-4105
Country : US
Telephone Number : 804-967-0486
Fax Number :
Provider Business Practice Location Address
First Line : 5412 GLENSIDE DR STE B
Second Line :
City : RICHMOND
State : VA
Zip : 23228-3995
Country : US
Telephone Number : 804-967-0486
Fax Number : 804-346-0066
Authorized Official
Title or Position : CEP
Name : DR. JAMES WOODROW FULLER JR.
Credential : PHD
Telephone Number : 804-967-0486
Provider Enumeration Date : 10/08/2006
Last Update Date : 05/07/2008

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