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General NPI Number Information
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NPI Number | 1417917311
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Entity Type | Individual
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Provider Name | CAROLYN BRUMM MCCORMICK MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 4308 LUDGATE ST
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City | LUMBERTON
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State | NC
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Zip | 28358-2461
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Country | US
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Telephone | 910-674-4392
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Fax | 866-295-6481
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Provider Business Mailing Address
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Address Line | 2914 N ELM ST PBM # 121
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City | LUMBERTON
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State | NC
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Zip | 28358-3010
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Country | US
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Telephone | 910-674-4392
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Fax | 866-295-6481
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20317
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License Number State | NC
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