Phillip Fullwood, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

36525 Issued in NC

Practice address

121 S Estes Dr
Suite 100
Chapel Hill, NC 27514-2868

Phone

(919) 913-4200

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Freedom House Recovery Center, Inc.

  • Community/Behavioral Health Agency
  • Chapel Hill, NC
  • NPI 1548490378
  NPD (past)
• Therapeutic Alternatives Incorporated

  • Clinical Social Worker
  • Asheboro, NC
  • NPI 1386662831

  Psychiatry

  NPD (past)
• Youth Development Corporation of America

  • Community/Behavioral Health Agency
  • Pittsboro, NC
  • NPI 1336280270
  NPD (past)
• Youth Development Corporation of America

  • Community/Behavioral Health Agency
  • Henderson, NC
  • NPI 1629023569
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1710909288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S ESTES DR",
            "address_2": "SUITE 100",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "27514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S ESTES DR",
            "address_2": "SUITE 100",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275142868",
            "telephone_number": "919-913-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLWOOD",
        "first_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "36525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404921",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fuller & Associates, P.a.
• Deja Fuller
• Edwin R Fuller III, MD
• Jessica Scott Fuller, M.D.
• Glynis Wikstrom Fullwood, LCSW
• Emmanuel Micayah Funchess
• Peter W Fung, DMD, MD
• Mackenzie Lynn Funk, MD
• Marie Funk
• William K Funkhouser, MD

• Psychiatry Physician in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.