Provider Demographics
NPI:1588656607
Name:FULTON, JAMES CLARK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CLARK
Last Name:FULTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 3420 BOX 233
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AA
Mailing Address - Zip Code:34039-0233
Mailing Address - Country:US
Mailing Address - Phone:202-448-9095
Mailing Address - Fax:
Practice Address - Street 1:UNIT 3420 BOX 200
Practice Address - Street 2:DEPARTMENT OF STATE, US EMBASSY QUITO, ECUADOR
Practice Address - City:DPO
Practice Address - State:AA
Practice Address - Zip Code:34039-0200
Practice Address - Country:US
Practice Address - Phone:202-448-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004539363AS0400X
VA0110003730363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical