1659351468 NPI number — PRESLEY FULTZ HOWLETT MD

Table of content: PRESLEY FULTZ HOWLETT MD (NPI 1659351468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659351468 NPI number — PRESLEY FULTZ HOWLETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWLETT
Provider First Name:
PRESLEY
Provider Middle Name:
FULTZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSIER
Provider Other First Name:
PRESLEY
Provider Other Middle Name:
FULTZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659351468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3815 FABER PLACE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29405-8533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-767-9312
Provider Business Mailing Address Fax Number:
843-767-9313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3815 FABER PLACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29405-8533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-767-9312
Provider Business Practice Location Address Fax Number:
843-767-9313
Provider Enumeration Date:
01/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  20406 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 204068 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".