Organization
GOLDSBORO MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS A FULLINGTON MD (PARTNER/OWNER)
(919) 739-9060
Entity
Organization
Contact information
Practice address
2400 WAYNE MEMORIAL DR, STE I, GOLDSBORO, NC 27534
(919) 739-9060
(919) 739-9099
Mailing address
2400 WAYNE MEMORIAL DR, STE I, GOLDSBORO, NC 27534
(919) 739-9060
(919) 739-9099
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20000016
NC
207R00000X
Internal Medicine Physician
29490
NC
207R00000X
Internal Medicine Physician
Primary
9600641
NC
207R00000X
Internal Medicine Physician
9600773
NC
207R00000X
Internal Medicine Physician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0317M
BLUE CROSS BLUE SHIELD
NC
05
—
890317M
—
NC
Enumeration date
05/31/2006
Last updated
08/22/2020
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