Healthcare Provider Details

I. General information

NPI: 1518955269
Provider Name (Legal Business Name): JOSEPH EARL ROBERTS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 N ELM ST
LUMBERTON NC
28358-2984
US

IV. Provider business mailing address

3005 N ELM ST
LUMBERTON NC
28358-2984
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-7789
  • Fax: 910-738-7599
Mailing address:
  • Phone: 910-738-7789
  • Fax: 910-738-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32959
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number32959
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32959
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number32959
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number32959
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: