Provider Demographics
NPI:1598830598
Name:FULCHER, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:FULCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0699
Mailing Address - Country:US
Mailing Address - Phone:843-887-3344
Mailing Address - Fax:843-887-3811
Practice Address - Street 1:631 VENNING ST
Practice Address - Street 2:
Practice Address - City:MC CLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458-0699
Practice Address - Country:US
Practice Address - Phone:843-887-3344
Practice Address - Fax:843-887-3811
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC6135Medicaid
SCSC6135Medicaid
D992390281Medicare ID - Type Unspecified