Provider Demographics
NPI:1346389236
Name:FULBRIGHT, RENEE ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ANNETTE
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:ANNETTE
Other - Last Name:HUMPHRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3748 TEA OLIVE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-6100
Mailing Address - Country:US
Mailing Address - Phone:704-865-4317
Mailing Address - Fax:
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE GASTON MEMORIAL HOSP.
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-834-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300619207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine