Healthcare Provider Details

I. General information

NPI: 1285218933
Provider Name (Legal Business Name): DR. ROBIN PEACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 PINE RUN DR
LUMBERTON NC
28358-2118
US

IV. Provider business mailing address

1105 LAUREL OAK LN
LUMBERTON NC
28358-2183
US

V. Phone/Fax

Practice location:
  • Phone: 910-734-6247
  • Fax: 754-212-0473
Mailing address:
  • Phone: 910-734-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBIN YOLANDA PEACE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 910-734-6247