Derrick Cornelius Fullwood

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

4442 Bonnetsville Rd
Clinton, NC 28328-1001

Phone

(919) 673-6332

NPI assigned

Oct 6, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1254787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254787200000",
    "number": "1154656338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4337 LAKE RIDGE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276043469",
            "telephone_number": "919-673-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4442 BONNETSVILLE RD",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283281001",
            "telephone_number": "919-673-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLWOOD",
        "first_name": "DERRICK",
        "middle_name": "CORNELIUS",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-06",
        "last_updated": "2009-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andres R Fleury-Guzman, MD
• FLR Counseling LLC
• Forest Trail of Clinton, LLC
• Fuller & Associates VII PLLC
• Rashida Asha Fuller, LCSW-A
• Michael A Galletti, D.O.
• Gateway to Better Help, LLC
• Mary Katrina Snyder Gaylord, MD
• Ryan S Geist
• Crystal Gillis, FNP

• Community/Behavioral Health Agency in Clinton, NC
• Providers in Clinton, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2009; 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.