Healthcare Provider Details

I. General information

NPI: 1932318623
Provider Name (Legal Business Name): LUMBERTON OBSTETRICS & GYNECOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WOODRIDGE DR.
LUMBERTON NC
28358
US

IV. Provider business mailing address

1003 WOODRIDGE DR.
LUMBERTON NC
28358
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-9601
  • Fax: 910-671-8264
Mailing address:
  • Phone: 910-738-9601
  • Fax: 910-671-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200700743
License Number StateNC

VIII. Authorized Official

Name: CHERYL A BECKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-738-9601