MEDICARE: MR. NATHANIEL ASBURY FULLER PA-C

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1912330945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL ASBURY FULLER PA-C

Provider Business Mailing Address
First Line	:	6521 BUENA VISTA CT
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-9416
Country	:	US
Telephone Number	:	706-651-2369
Fax Number	:

Provider Business Practice Location Address
First Line	:	3019 N CENTER ST
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-1160
Country	:	US
Telephone Number	:	706-910-6708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	03/27/2025

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