Provider Demographics
NPI:1689688301
Name:FULLER, JAMES MORRISON JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MORRISON
Last Name:FULLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 EPTING AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4041
Mailing Address - Country:US
Mailing Address - Phone:864-227-6818
Mailing Address - Fax:864-227-0850
Practice Address - Street 1:421 EPTING AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4041
Practice Address - Country:US
Practice Address - Phone:864-227-6818
Practice Address - Fax:864-227-0850
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39591207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC395913Medicaid
SCSC8325Medicare PIN
SC395913Medicaid