Healthcare Provider Details

I. General information

NPI: 1598741985
Provider Name (Legal Business Name): ALAN DENNIS LINDSLEY PHYSCIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 SOUTH PEAK DR HOPE MILLS MEDICAL HOME
FAYETTEVILLE NC
28306
US

IV. Provider business mailing address

402 S MAIN ST
RAEFORD NC
28376-3223
US

V. Phone/Fax

Practice location:
  • Phone: 910-908-4673
  • Fax: 910-908-2241
Mailing address:
  • Phone: 910-875-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101993
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: