Provider Demographics
NPI:1215978739
Name:REDDING, JOHN FULTON II (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FULTON
Last Name:REDDING
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:2415 PHILADELPHIA LAKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4300
Mailing Address - Country:US
Mailing Address - Phone:336-302-2082
Mailing Address - Fax:
Practice Address - Street 1:5921 W FRIENDLY AVE STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3268
Practice Address - Country:US
Practice Address - Phone:336-551-5830
Practice Address - Fax:336-268-3160
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-03-26
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Provider Licenses
StateLicense IDTaxonomies
NC9501388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
80928OtherMEDCOST
NC89-70737Medicaid
70737OtherBCBS
80928OtherMEDCOST
70737OtherBCBS