Full Potential Life LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

FULL POTENTIAL LIFE LLC

Practice address

1530 N Gregson St
Suite 3-D
Durham, NC 27701-1155

Phone

(919) 321-6171

Fax

(888) 805-6175

NPI assigned

Jul 16, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Logan Graddy, M.D.

Title

Psychiatrist

Phone

(919) 321-6171

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247702400000",
    "number": "1568692127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 N GREGSON ST",
            "address_2": "SUITE 3-D",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277011155",
            "telephone_number": "919-321-6171",
            "fax_number": "888-805-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 N GREGSON ST",
            "address_2": "SUITE 3-D",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277011155",
            "telephone_number": "919-321-6171",
            "fax_number": "888-805-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL POTENTIAL LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2009-07-16",
        "status": "A",
        "authorized_official_last_name": "GRADDY",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "919-321-6171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D'Ericka L Fulgham-Artis
• Conrad Carnes Fulkerson, M.D.
• Katherine Cynthia Fulkerson, PHD
• William Fulkerson, M.D.
• Full Potential Behavioral Health Care, Inc.
• Fuller & Associates VIII PLLC
• Brian George Fuller, PT
• Emily Fuller
• Farrah Fuller
• Mazella B. Fuller, PHD MSW LCSW

• Adult Mental Health Clinic/Center in Durham, NC
• Providers in Durham, NC by specialty
• Adult Mental Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.