Active NPI
David Lee Fuller, M.D.
- Child & Adolescent Psychiatry Physician
- Greensboro, NC
National Provider Identifier
1841359262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 20393
- Practice address
- 612 Pasteur Dr
Ste 200
Greensboro, NC 27403-1149 - Phone
- (336) 852-4051
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 20393 | NC | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 20393 | NC | Primary |
Addresses
Primary practice location
612 Pasteur Dr
Ste 200
Greensboro, NC 27403-1149
Mailing address
612 Pasteur Dr
Ste 200
Greensboro, NC 27403-1149
Phone (336) 852-4051
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24019 | Other | NC | MEDCOST |
| 34114 | Other | NC | BCBS NC |
| 8911441 | Medicaid | NC |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20393 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1841359262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 PASTEUR DR",
"address_2": "STE 200",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274031149",
"telephone_number": "336-852-4051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 PASTEUR DR",
"address_2": "STE 200",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274031149",
"telephone_number": "336-852-4051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "DAVID",
"middle_name": "LEE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "20393",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "NC",
"license": "20393",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "24019",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "34114",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8911441",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.