Provider Demographics
NPI:1932474111
Name:FULGHUM, GEORGE HEYWARD III (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HEYWARD
Last Name:FULGHUM
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5153 N 9TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5719
Practice Address - Country:US
Practice Address - Phone:850-416-6159
Practice Address - Fax:850-416-7198
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-8208208600000X
MST-2951208600000X
FLOS16136208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery