MEDICARE: STEDMAN FAMILY CLINIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	103685	NC

General Provider Information

NPI Number	:	1194844498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEDMAN FAMILY CLINIC, PLLC

Provider Business Mailing Address
First Line	:	7513 CLINTON RD.
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391
Country	:	US
Telephone Number	:	910-483-7776
Fax Number	:	910-483-1373

Provider Business Practice Location Address
First Line	:	7513 CLINTON RD.
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391-0358
Country	:	US
Telephone Number	:	910-483-7776
Fax Number	:	910-483-1373

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CONNIE L BROOKS-HERNANDEZ
Credential	:	M.D.
Telephone Number	:	910-483-7776

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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