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NPI Code Detail

MEDICARE: JESSICA FULLER-HINES M.D.

MEDICARE: JESSICA FULLER-HINES M.D.
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
1208100000XPhysical Medicine & Rehabilitation Physician2007-00519NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790807824
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA FULLER-HINES M.D.
Provider Business Mailing Address
First Line : 135 E RICH BLVD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-5518
Country : US
Telephone Number : 252-333-1277
Fax Number : 252-333-1877
Provider Business Practice Location Address
First Line : 135 E RICH BLVD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-5518
Country : US
Telephone Number : 252-333-1277
Fax Number : 252-333-1877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 06/10/2013

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