Individual
CHARLES A FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 BROOKSIDE DR, KINGSPORT, TN 37660-4627
(423) 857-7870
(423) 857-7872
Mailing address
PO BOX 5789, JOHNSON CITY, TN 37602-5789
(423) 915-1126
(423) 915-0635
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18954
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3034213
—
TN
Enumeration date
10/23/2006
Last updated
07/08/2007
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