Individual
PEGGY A FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
353 CLEMENT AVE, CHARLOTTE, NC 28204-2431
(704) 370-2700
(704) 370-2702
Mailing address
353 CLEMENT AVE, CHARLOTTE, NC 28204-2431
(704) 370-2700
(704) 370-2702
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9700555
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9700555
STATE LICENSE NUMBER
NC
Enumeration date
08/22/2006
Last updated
07/08/2007
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