Individual
JESSICA FULLER-HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
135 E RICH BLVD, ELIZABETH CITY, NC 27909-5518
(252) 333-1277
(252) 333-1877
Mailing address
135 E RICH BLVD, ELIZABETH CITY, NC 27909-5518
(252) 333-1277
(252) 333-1877
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2007-00519
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5907327
—
NC
Enumeration date
04/06/2007
Last updated
06/10/2013
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