Active NPI
Edward A Fulghum, PTA
- Physical Therapy Assistant
- Smithfield, NC
National Provider Identifier
1043799208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5326
- Practice address
- 509 N Brightleaf Blvd
Smithfield, NC 27577-4407 - Phone
- (919) 934-8171
- NPI assigned
- Aug 8, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5326 | NC | Primary |
Addresses
Primary practice location
509 N Brightleaf Blvd
Smithfield, NC 27577-4407
Mailing address
1209 Peele Rd
Clayton, NC 27520-6863
Phone (252) 292-2816
Other practice location 1
902 Berkshire Rd
Smithfield, NC 27577-4731
Phone (919) 934-3171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5326 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533686400000",
"number": "1043799208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 PEELE RD",
"city": "CLAYTON",
"state": "NC",
"postal_code": "275206863",
"telephone_number": "252-292-2816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 N BRIGHTLEAF BLVD",
"city": "SMITHFIELD",
"state": "NC",
"postal_code": "275774407",
"telephone_number": "919-934-8171"
}
],
"practiceLocations": [
{
"address_1": "902 Berkshire Rd",
"address_purpose": "LOCATION",
"city": "Smithfield",
"state": "NC",
"postal_code": "275774731",
"country_code": "US",
"telephone_number": "919-934-3171",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FULGHUM",
"first_name": "EDWARD",
"middle_name": "A",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-08",
"last_updated": "2018-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "5326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithfield, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.