Individual
SALLY S FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
735 MCMILLAN RD, CLEMSON, SC 29634-4054
(864) 656-2233
(864) 656-0760
Mailing address
735 MCMILLAN RD, CLEMSON, SC 29634-4054
(864) 656-2233
(864) 656-0760
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
27518
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34116
BCBS
NC
05
—
8934116
—
NC
01
—
930043479
RAILROAD
NC
05
—
Q27519
—
SC
Enumeration date
04/12/2006
Last updated
05/03/2016
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