Provider Demographics
NPI:1225017544
Name:HULBERT, HARRY TURNER III (PAC)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:TURNER
Last Name:HULBERT
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-759-7596
Mailing Address - Fax:336-759-3652
Practice Address - Street 1:1995 BETHABARA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3375
Practice Address - Country:US
Practice Address - Phone:336-759-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000101889363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC94707OtherMEDCOST
7302753OtherAETNA
7302753OtherAETNA
R96944Medicare UPIN