Individual
DR. SEAN DOUGLAS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7182 WOODROW ST STE 200, IRMO, SC 29063-2958
(803) 749-1111
(803) 749-0050
Mailing address
7182 WOODROW ST STE 200, IRMO, SC 29063-2832
(803) 749-1111
(803) 749-0050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20144
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201445
—
SC
Enumeration date
02/28/2006
Last updated
02/26/2024
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