Goldsboro Medical Clinic PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9600641 Issued in NC

Legal business name

GOLDSBORO MEDICAL CLINIC PA

Practice address

2400 Wayne Memorial Dr
Ste I
Goldsboro, NC 27534

Phone

(919) 739-9060

Fax

(919) 739-9099

NPI assigned

May 31, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Douglas A Fullington, MD

Title

Partner/Owner

Phone

(919) 739-9060

Specialties & licenses 5

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Howard W Newell Jr., MD

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1457310971
  NPD
• Thaddeus C West Jr., MD

  • Internal Medicine Physician
  • Goldsboro, NC
  • NPI 1932169034
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144267204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 WAYNE MEMORIAL DR",
            "address_2": "STE I",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-739-9060",
            "fax_number": "919-739-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 WAYNE MEMORIAL DR",
            "address_2": "STE I",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27534",
            "telephone_number": "919-739-9060",
            "fax_number": "919-739-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDSBORO MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FULLINGTON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER/OWNER",
        "authorized_official_telephone_number": "919-739-9060",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "29490",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9600773",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9600641",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "20000016",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0317M",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890317M",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Goldsboro Family Young Men's Christian Association
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• Goldsboro Medical Specialists PA
• Goldsboro Neurological Surgery, PA
• Goldsboro OB-GYN, Associates, PLLC
• Goldsboro Opco LLC
• Goldsboro Orthopaedic Associates, PA

• Internal Medicine Physician in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.