Healthcare Provider Details

I. General information

NPI: 1598110108
Provider Name (Legal Business Name): ALEXANDRIA LLOYD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GUM BRANCH RD
JACKSONVILLE NC
28540-4574
US

IV. Provider business mailing address

2200 GUM BRANCH RD
JACKSONVILLE NC
28540-4574
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-9800
  • Fax: 910-455-2083
Mailing address:
  • Phone: 910-353-9800
  • Fax: 910-455-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA5782
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: