Healthcare Provider Details

I. General information

NPI: 1689870644
Provider Name (Legal Business Name): MCCHERAL EVANS LOFTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PAMALEE DR
FAYETTEVILLE NC
28301-2824
US

IV. Provider business mailing address

25 EDGECOMBE DR
SPRING LAKE NC
28390-9145
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2295
  • Fax:
Mailing address:
  • Phone: 910-497-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: