Provider Demographics
NPI:1669470357
Name:OBSTETRICS & GYNECOLOGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-582-4567
Mailing Address - Street 1:853 N CHURCH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3098
Mailing Address - Country:US
Mailing Address - Phone:864-582-4567
Mailing Address - Fax:864-582-5397
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:STE 400
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-582-4567
Practice Address - Fax:864-582-5397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4891207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B91878Medicare UPIN
SC3965Medicare ID - Type Unspecified