MEDICARE: DEZMOND BERNARD SUMTER

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	207QS1201X	Sleep Medicine (Family Medicine) Physician	34934	SC
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	2022-00128	NC
3	207Q00000X	Family Medicine Physician	2022-00128	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831452853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEZMOND BERNARD SUMTER

Provider Business Mailing Address
First Line	:	PO BOX 743904
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3904
Country	:	US
Telephone Number	:	803-296-7320
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	150 ROBESON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5519
Country	:	US
Telephone Number	:	910-615-1059
Fax Number	:	910-615-1058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	04/13/2026

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