Provider Demographics
NPI:1467485326
Name:FULBRIGHT, VIRGINIA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:4515 PREMIER DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8350
Practice Address - Country:US
Practice Address - Phone:336-802-2350
Practice Address - Fax:336-802-2351
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1212660012OtherDME - DEEP RIVER
NC1212660012OtherDME - DEEP RIVER
NC2766591BMedicare PIN
NC2766591Medicare PIN
NC2766591AMedicare PIN