Provider Demographics
NPI:1598031122
Name:FULTON, LATOYA DENISE (DO)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:DENISE
Last Name:FULTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:DENISE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 CAPITAL BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3487
Mailing Address - Country:US
Mailing Address - Phone:984-282-9402
Mailing Address - Fax:877-471-2993
Practice Address - Street 1:3901 CAPITAL BLVD STE 113
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3487
Practice Address - Country:US
Practice Address - Phone:984-282-9402
Practice Address - Fax:877-471-2993
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01188207Q00000X
GA3990200000X390200000X
OK5874390200000X
LA307098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program