Provider Demographics
NPI:1871075283
Name:FULLER, JAMES (PHD, DABCC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FULLER
Suffix:
Gender:M
Credentials:PHD, DABCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SEYMOUR PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6459
Mailing Address - Country:US
Mailing Address - Phone:919-274-8660
Mailing Address - Fax:
Practice Address - Street 1:120 PRESTON EXECUTIVE DR STE 211
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8445
Practice Address - Country:US
Practice Address - Phone:919-274-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician