Individual
JAMES MICHAEL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE B480, GREENVILLE, SC 29615-3593
(864) 454-4200
(864) 454-4205
Mailing address
300 E MCBEE AVE, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
18522
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5793335
CIGNA
SC
01
—
7461686
AETNA
SC
05
—
G14799
—
SC
01
—
P00265772
RR MEDICARE
SC
Enumeration date
06/14/2006
Last updated
05/12/2021
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