Healthcare Provider Details

I. General information

NPI: 1215477369
Provider Name (Legal Business Name): EMILY LOPES TOWNSEND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 QUIET CV
FAYETTEVILLE NC
28304-3985
US

IV. Provider business mailing address

4390 FAYETTEVILLE RD
LUMBERTON NC
28358-2677
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-2626
  • Fax:
Mailing address:
  • Phone: 910-738-7154
  • Fax: 910-738-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06912
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: