Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 19752 | NC |
NPI | 1013909571 |
---|---|
Provider Name | Edwin M. Fulghum |
First Address | Statesville, NC 28625-4353 |
Second Address | Statesville, NC 28625-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 24/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8934104 | (05) | NC |
C85742 | (02) | NC |