Provider Demographics
NPI:1558364828
Name:FULP, CAMMIE JO (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMMIE
Middle Name:JO
Last Name:FULP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 YANCEYVILLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6961
Mailing Address - Country:US
Mailing Address - Phone:743-223-2033
Mailing Address - Fax:743-223-4186
Practice Address - Street 1:1409 YANCEYVILLE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6961
Practice Address - Country:US
Practice Address - Phone:743-223-2033
Practice Address - Fax:743-223-4186
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136THMedicaid
NC136THOtherBCBSNC
NCNC2372AMedicare PIN
NC136THOtherBCBSNC
NC2283371AMedicare ID - Type UnspecifiedPROVIDER NUMBER